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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.