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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

A comparison of the social issues in recreational and habitual drug use is given. The solidarity reported by recreational users was to maintain low practices, while the social scene of addicts was not organized around such solidarities. Addicts exhibited traits of sensual hedonism whichh resulted inevitably in ever greater drug use.

Indepth interviews were recorded with 24 clients of female sex workers to explore their perspectives on the control of encounters. The men saw the encounter as falling into three phases, only the first of which - the decision to have sex - was under their control. Subsequent phases - the negotiation of services and the performance of sex - they argued to be under worker control. The men considered that they acquiesced in worker control because they saw themselves as respectful of a woman's right to control her body and because they considered themselves attentive to workers' sexual pleasure. At the same time, this acquiescence was considered to exculpate them from any responsibility for safer sex practice. Thus while the men argued they were consistent condom users, they held their partners responsible for ensuring this consistent condom use: women supplied condoms, and were held accountable for any condom failures. The discourse of these men therefore functioned both to present clients benignly and to exculpate them from any responsibility for ensuring the safety of the commercial sex encounter. [ABSTRACT FROM AUTHOR]