Peacenik Ken’s no-control zone

Clarke remains remains delightfully unspun in the era of control freakery.

Do broadcasters expect the creaky coalition to collapse, scenting the people's toff, David Cameron, will seek the approval of his distant relative the Queen for an early general election? The Con-Dem pact is supposed to last until Thursday 7 May 2015. That's four and a bit years into the future. Yet I hear telly types have written to Ed Miliband asking the Labour leader to take part in TV election debates.

The approach strikes your correspondent as a tad premature, unless, of course, the BBC, ITV and Sky sniff a cooling in the once-intense love between Dave and Nick. It wouldn't be the first civil partnership to end in divorce over rowdy kids.

Wealthier Lib Dems billeted in the four-star Mercure complained the water ran tepid, not hot, during the yellow-bellies' spring retreat behind a wall of steel in Sheffield. Lukewarm showers may be considered too good for Clegg and co by the party's critics, including many in its coalition partner. Public spending cuts are poised to bite hard but there was no sign of austerity at the HQ hotel. Empty champagne bottles my snout stepped over in corridors suggested it was party time for the Lib Dumb high command.

To Teignmouth for Any Questions with, among others, Ken Clarke. The Injustice Secretary drove himself to Devon from London and remains delightfully unspun in the era of control freakery. I would wager that the flak Peacenik Ken put up over Wing Commander Cameron's Libyan no-fly zone wasn't in the cabinet brief. Clarke's pro-European and liberal with a small "l" views make him a constant target for the Mail, Torygraph, Sun and Express. The insouciance with which this Conservative member of the cabinet dismisses Tory rags as "the right-wing media" must horrify pimpled spin doctors. And it's worse than fulminating editors of the blue press think: Clarke reads the yellow Indie.

"Sir" George Osborne's trainee attack puppy, Matthew Hancock, is a persistent breed. The young MP issued two near-identical press releases within the space of five days accusing Ed "Bruiser" Balls of losing £9bn on Treasury gold sales 12 years ago. The only change was the metal's price of $1,437 in the first then $1,444 in the second. Neither missive, as far as I could see, received coverage. Hancock should adopt the motto: "If at first you don't succeed, try and fail again."

Accident-prone Ipsa commits so many errors, the expenses police were forced to warn MPs that they accept "no liability, including liability for negligence" for email blunders by the force's own staff. MPs accused of fiddling should adopt the same weasel tactics.

The Commons will no longer bloom as brightly in the spring. Expenditure on flowers is to be slashed by£29,000 to £87,000. That's good news for hay-fever sufferers, and still seems quite a lot. But will there be enough for Lord Janner's vivid lapel?

Cuts bite, too, in Commons canteens. Doughnuts have halved in size, despite the price remaining at 60p.

Kevin Maguire is associate editor (politics) of the Daily Mirror

Kevin Maguire is Associate Editor (Politics) on the Daily Mirror and author of our Commons Confidential column on the high politics and low life in Westminster. An award-winning journalist, he is in frequent demand on television and radio and co-authored a book on great parliamentary scandals. He was formerly Chief Reporter on the Guardian and Labour Correspondent on the Daily Telegraph.

This article first appeared in the 21 March 2011 issue of the New Statesman, The drowned world

Christopher Furlong/Getty Images
Show Hide image

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