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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

New Zealand research suggests that CAM use by GPs has decreased, while referral to CAM practitioners by GPs has increased, and that patients often do not tell their health practitioners when they are using CAM. The New Zealand Medical Council has developed guidelines for GPs who use CAM. However, there is no research in New Zealand that looks at how patients and GPs respond to CAM issues in the consultation. This paper uses data collected for two research projects on doctor-patient interaction. For this research, consultations between 105 patients and nine GPs were video-recorded. In this data set, all doctors but one were 'orthodox' and to some degree reserved judgement on CAM, albeit remaining cautious in how they made this evident. Patients on the other hand demonstrated a variety of strategies to get CAM on the agenda, and GPs were careful to couch any criticism in such a way as to protect the 'face' of patients. [ABSTRACT FROM AUTHOR]

Psychological control has been hypothesized to play a central role in the aetiology and maintenance of anorexia nervosa (AN). Indeed, by positioning psychological control as an important organizing or underlying causal mechanism, theoretical accounts typically rely on this construct. This paper reviews three strategically important accounts of the hypothesized relationship between psychological control and AN. These theoretically articulated relationships are complex and diverse. The implications of this situation for current clinical practice, and future research questions, are discussed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The links between risk-taking, identity and social context were examined in interviews with 20 young injecting drug users. Young men proclaimed accounts of identity either as 'recreational users' with the heroic personal characteristics to control their drug use, or as 'junkies' with traits of sensual hedonism leading inevitably to ever-increasing drug use. Young women's accounts were of themselves as 'junkies' driven to drug use by psychological pain and addictive personality. Drawing upon individualised explanations of behaviour, these discourses of self identity could nevertheless be seen to be linked to specific social practices: recreational users reported solidarities to maintain low drug use whereas the social scene of 'junkies' was not organised around such solidarities. Those who oscillated between recreational use and habitual use had moved across these different social contexts. Theories and practical strategies for harm minimisation, which recognise these relationships between self-identity, social context and behaviour, are called for. [ABSTRACT FROM AUTHOR]

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]