Morning Call: pick of the papers

The ten must-read comment pieces from this morning's papers.

1. The next election may be a year away, but Osborne is on the campaign trail. It’s a risky strategy (Independent)

A party’s pre-election "tax and spend" plans can withstand scrutiny for six months but not for a year and a half, says Steve Richards.

2. Minimum wage rise could be a Tory winner (Times)

Cameron needs a surprise move to rebuild his party’s image, writes Rachel Sylvester. It may come with a boost for the low paid.

3. Young should blame bad luck not policy (Financial Times)

The baby boomers enjoyed almost miraculously benign circumstances that will not be repeated, writes Janan Ganesh.

4. George Osborne's cuts are a squeeze too far (Guardian)

Cuts on the scale the chancellor is suggesting would be extreme – and they are not necessary, says IFS head Paul Johnson.

5. A Smaller State (Times)

The government is right to seek more cuts — but it is unfair to load the burden on to the young, says a Times editorial.

6. There's a new climate of diktat and fear sweeping through the NHS (Guardian)

An occupational therapist who won awards for her work has been sacked for querying cuts to a stroke unit, writes Polly Toynbee.

7. Cameron’s plan for 2014 is to prove he’s a man of his word (Daily Telegraph)

This year will be the Tory leadership’s chance to show that its promises are worth having, writes Benedict Brogan.

8. Take inspiration from Sarajevo, not Munich (Financial Times)

Pointless aggression belongs in the playground, not in international affairs, says Gideon Rachman.

9. Pragmatic public wants immigration mended, not ended (Independent)

People may prefer to see immigration at lower levels – but they don’t want to turn away the positive contribution from migrants, says Sunder Katwala.

10. Betting-shop machines sucking cash out of communities … this is what predatory capitalism looks like (Guardian)

While giving councils greater powers to block new gambling shops, it would be better to cut the maximum stake on fixed-odds betting terminals, says Aditya Chakrabortty.

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide