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Although a diagnosis of a life‐limiting cancer is likely to evoke emotions, such as fear, panic and anxiety, for some people it can also provide an opportunity to live life differently. This article is based on research undertaken in Aotearoa New Zealand on the topic of exceptional cancer trajectories. Eighty‐one participants who had been identified as living with a cancer diagnosis longer than clinically expected were interviewed, along with 25 people identified by some of the participants as supporters in their journey. For some participants the diagnosis provided the opportunity to rethink their lives, to undertake lifestyle and consumption changes, to be culturally adventurous, to take up new skills, to quit work and to change relationships with others. The concepts of biographical disruption and posttraumatic growth are considered in relation to these accounts, and it is argued that the event of a cancer diagnosis can give license for people to breach social norms. [ABSTRACT FROM AUTHOR]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01229.x Byline: Kevin Dew (1), Maria Stubbe (2), Lindsay Macdonald (2), Anthony Dowell (2), Elizabeth Plumridge (2) Keywords: elective surgery; prioritisation tools; doctor-patient interaction Abstract: Abstract Priority setting and rationing is a dominant feature of contemporary health policy. In New Zealand, clinical priority assessment criteria (CPAC) tools have been developed to make access to elective surgery more equitable and efficient. Research was undertaken to identify how surgeons used these tools in the consultation. Forty-seven consultations with 15 different surgeons have to date been video- and audio-recorded. There were no instances where CPAC tools were explicitly used in the consultation. Drawing on the methodology of conversation analysis and the concept of news delivery as developed by Maynard, this paper argues that the delivery of diagnoses and treatment plans can usefully be seen in part as the delivery of bad or good news. Using three case studies to illustrate the argument, it is suggested that the interactional work required in the delivery of such news challenges the ability of clinicians to use protocols such as CPAC. The analysis sheds light on important consultation processes that need to be more carefully considered when designing interventions to influence clinician behaviour. In order to influence the behaviour of clinicians to achieve policy goals, greater attention needs to be paid to the interactional demands of the consultation process. Author Affiliation: (1)Sociology Programme, Victoria University of Wellington, New Zealand (2)Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand Article note: Address for correspondence: Kevin Dew, Sociology Programme, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand, e-mail: Kevin.dew@vuw.ac.nz

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01169.x Byline: Kevin Dew, Trina Taupo Keywords: New Zealand; Durkheim; public health; anomie; workplace; presenteeism Abstract: Abstract This paper draws on Durkheimian concepts of moral forces, particularly anomie and fatalism, and the forced division of labour, to argue that the current institutional arrangements to protect and compensate workers in hazardous workplaces are insufficient. This argument is illustrated with interview data from workers at a meatworks in New Zealand which examined workers' responses to illness and injury in the workplace. It is suggested that an imbalance in moral forces leads to pathological outcomes for workers - seen in presenteeism - the phenomenon of staying at work when injured or ill - and workplace injustice. There are state institutions such as worker compensation schemes and occupational safely and health regulations, and other intermediary groups such as unions, that can act as a buffer against anomic and fatalistic forces in the workplace, but at present these countervailing regulatory and advocacy forces are not sufficiently protective of vulnerable workers. Public health advocacy and research could fill the current void. Article note: Address for correspondence: Kevin Dew, Sociology Programme, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand e-mail: Kevin.dew@vuw.ac.nz

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2007.01022.x Byline: Kevin Dew (1), Sonya Morgan (2), Anthony Dowell (2), Deborah McLeod (2), John Bushnell (3), Sunny Collings (4) Keywords: mental health; general practice; doctor-patient relationship; fear; trust Abstract: Abstract Research indicates that there is a high level of trust in health professionals but also a high level of non-disclosure of mental health issues to general practitioners (GPs). This paper explores the issue of patients' willingness to disclose mental health problems to GPs through interviews with 33 patients from the lower half of the North Island of New Zealand. Patients' willingness to disclose related to a range of factors but this paper focuses on fear and sense of control as these issues have received little attention in the extant literature and provide important discussion points for the conduct of consultations. Fear of the consequences of consultation warrants attention if general practice is to be promoted as the preferred point of contact for mental health consultations. The research reported here suggests that trust in a range of institutions and agencies, not just in the individual practitioner, would need to be achieved for the GP to be the preferred point of contact. Author Affiliation: (1)Public Health, University of Otago, Wellington, New Zealand (2)Primary Care and General Practice, University of Otago, Wellington, New Zealand (3)Graduate School of Medicine, University of Wollongong, Australia (4)Psychological Medicine, University of Otago, Wellington, New Zealand Article note: Address for correspondence: Kevin Dew, Public Health, University of Otago, PO Box 7343, Wellington South, Wellington 6002, New Zealand, e-mail: kevin.dew@otago.ac.nz

Homeopathy, along with many other alternative therapies, has come under severe attack from apologists for orthodox medicine. Given the cultural authority of medicine, what then provides the impetus for people to take up homeopathy as a clinical practice? This article addresses this question in the context of homeopathic practice in New Zealand. Five focus groups were conducted with 22 homeopaths in five cities. The study found that it was common to be drawn to homeopathy through witnessing in themselves, their family, friends or animals, the positive effects of homeopathy, commonly after negligible success from conventional medicine. For many participants, all of whom were women, the opportunity to study homeopathy occurred when they were the primary carers of children, with homeopathy providing a possibility for a change in work trajectories. Many participants had previous occupations inside the conventional health system. Central to the appeal of homeopathy as a subaltern practice in New Zealand is the often dramatic impact of witnessing the effects of the therapeutic modality, which is conceptualised as analogous to an 'event' that tears at the fabric of the everyday. [ABSTRACT FROM AUTHOR]

The Royal Commission of Inquiry assessment of chiropractic in New Zealand in 1978 is discussed, and revealed a tension between the medical debate and the chiropractic one. A compromise gave chiropractic a place in the public health service in New Zealand and 'de-radicalized' its claims.