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Background: Primary health care has an important role to play in the management of weight and yet discussions of healthy weight management do not occur optimally, indicating a need for simple tools and training in brief weight counselling. The 'FABS' approach (focusing on four topic areas: Food, Activity, Behaviour and Support) was developed to address this.Objectives: To explore the feasibility of the 'FABS' approach within routine general practice consultations and its effectiveness in facilitating healthy weight conversations.Method: The FABS approach was run for a trial period in five New Zealand general practices. The approach entailed staff training, the addition to the practice patient management system of a template outlining potential topics for discussion and a patient handout. GPs were asked to use the approach with any adult patient with a body mass index of over 28 kg/m2. A descriptive analysis of anonymized quantitative practice data was conducted, with limited qualitative data from an online clinician questionnaire and interviews with GPs and patients.Results: Over 4 months, the template was opened 862 times by 27 clinicians in 830 patient consultations. All FABS topics were raised at least once. Physical activity was raised most frequently, followed by two food-related topics. There was variation between practices and between GPs. GPs tended to raise more topics within a single consultation than the training recommended. The limited clinician survey results and patient interviews also indicated positive responses to the approach.Conclusions: It is possible to provide an infrastructure for healthy weight conversation approaches within general practice so that patients receive supportive and consistent messages on a regular basis. General practice is an appropriate setting for this due to the ongoing relationships with patients and team-based approach, but there is a need for effective training and education to ensure appropriate and effectively delivery. [ABSTRACT FROM AUTHOR]

Purpose: We undertook a study to observe in detail the primary care interactions and communications of patients with newly diagnosed diabetes over time. In addition, we sought to identify key points in the process where miscommunication might occur.Methods: All health interactions of 32 patients with newly diagnosed type 2 diabetes were recorded and tracked as they moved through the New Zealand health care system for a period of approximately 6 months. Data included video recordings of patient interactions with the health professionals involved in their care (eg, general practitioners, nurses, dietitians). We analyzed data with ethnography and interaction analysis.Results: Challenges to effective communication in diabetes care were identified. Although clinicians showed high levels of technical knowledge and general communication skill, initial consultations were often driven by biomedical explanations out of context from patient experience. There was a perception of time pressure, but considerable time was spent with patients by health professionals repeating information that may not be relevant to patient need. Health professionals had little knowledge of what disciplines other than their own do and how their contributions to patient care may differ.Conclusions: Despite current high skill levels of primary care professionals, opportunities exist to increase the effectiveness of communication and consultation in diabetes care. The various health professionals involved in patient care should agree on the length and focus of each consultation. [ABSTRACT FROM AUTHOR]

Background: Gout is the most common form of inflammatory arthritis. It is associated with substantial co-morbidity and often managed in primary care. A greater understanding of the communication process between patients and healthcare professionals provides one way of improving the management of this condition. This paper describes communication about gout medicines and treatment between patients and primary care health professionals during routine consultations. Methods: Video-recordings of 31 individual healthcare consultations between patients and a range of primary care practitioners (general practitioners, practice nurses, podiatrists, dietitians) from an archived database were reviewed. Consultations that encompassed any discussion about gout medicines and treatment were included (n = 27) and were not solely restricted to those where gout was the presenting complaint. Themes were derived from an inductive qualitative analysis, from clinical and linguistic perspectives, based on the conversation between patients and practitioners about medicines and visual observation of these interactions. Results: A number of factors were identified that had the potential to impact on the optimal management of gout in primary care. These included level of patient knowledge, patient attitudes to medicines, and the attributes of practitioner communication with patients. The latter related to the style of delivery and content of the information provided, and the ability of practitioners to make use of opportunities that arose to discuss these issues. Conclusions: Patients with gout communicate at varying levels of complexity with a diverse range of primary care healthcare professionals about the treatment of their condition. It is important that all practitioners engaging with gout patients in this setting are knowledgeable about the current management of gout, provide clear, consistent and accurate messages, remain aware that these messages may need repeating over time, and are supportive of patients’ medicine-taking preferences. [ABSTRACT FROM AUTHOR]

Background There is an assumption that there is a similarity between surgeon-patient and primary care consultations. Yet, surgeon communication has had far less analytic attention than its primary care counterparts. Therefore, this assumption of similarity (and the proposition here of dissimilarity) has yet to be evidenced through detailed interactional analysis. Methods Conversation analysis ( CA) is a methodology used to understand both mundane and institutional interactions. Using CA, we have developed an understanding of surgeon-patient interactions in outpatient clinic settings in New Zealand. Rather than attempting to determine what 'bad' communication is, we describe and analyse what occurs routinely in surgeon-patient consultations, particularly how these interactions are built up by both patient and doctor. Results This research shows that while surgeon-patient consultations share some similarities to the overall structure of primary care consultations, there are two unique structures that occur in surgical consultations. These structures follow a logical progression of activities and are influenced by the type of visit (referred versus follow-up). Discussion This article summarizes the first comprehensive description of the overall interactional structure of surgeon-patient consultations. It demonstrates that surgeon-patient consultations are structurally distinct from primary care consultations. This key finding has implications for surgeon-specific research and education, highlighting the need to question current assumptions in communication training and in clinical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND AND CONTEXT: New Zealand is becoming more ethnically diverse, with more limited English proficiency (LEP) people. Consequently there are more primary care consultations where patients have insufficient English to communicate adequately. Because effective communication is essential for good care, interpreters are needed in such cases. ASSESSMENT OF PROBLEM: The literature on the use of interpreters in health care includes the benefits of using both trained interpreters (accuracy, confidentiality, ethical behavior) and untrained interpreters (continuity, trust, patient resistance to interpreter). There is little research on the actual pattern of use of interpreters. RESULTS: Our research documented a low use of trained interpreters, despite knowledge of the risks of untrained interpreters and a significant use of untrained interpreters where clinicians felt that the communication was acceptable. A review of currently available guidelines and toolkits showed that most insist on always using a trained interpreter, without addressing the cost or availability. None were suitable for direct use in New Zealand general practice. STRATEGIES FOR IMPROVEMENT: We produced a toolkit consisting of flowcharts, scenarios and information boxes to guide New Zealand practices through the structure, processes and outcomes of their practice to improve communication with LEP patients. This paper describes this toolkit and the links to the evidence, and argues that every consultation with LEP patients requires clinical judgement as to the type of interpreting needed. LESSONS: Primary care practitioners need understanding about when trained interpreters are required. [ABSTRACT FROM AUTHOR]

Background. There is a widely held expectation that GPs will routinely use opportunities to provide opportunistic screening and brief intervention for alcohol and other drug (AOD) abuse, a major cause of preventable death and morbidity.Aim. To explore how opportunities arise for AOD discussion in GP consultations and how that advice is delivered.Design. Analysis of video-recorded primary care consultationsSetting. New Zealand General Practice.Methods. Interactional content analysis of AOD consultations between 15 GP’s and 56 patients identified by keyword search from a bank of digital video consultation recordings.Results. AOD-related words were found in almost one-third (56/171) of the GP consultation transcripts (22 female and 34 male patients). The AOD dialogue varied from brief mention to pertinent advice. Tobacco and alcohol discussion featured more often than misuse of anxiolytics, night sedation, analgesics and caffeine, with only one direct enquiry about other (unspecified) recreational drug use. Discussion was associated with interactional delicacy on the part of both doctor and patient, manifested by verbal and non-verbal discomfort, use of closed statements, understatement, wry humour and sudden topic change.Conclusions. Mindful prioritization of competing demands, time pressures, topic delicacy and the acuteness of the presenting complaint can impede use of AOD discussion opportunities. Guidelines and tools for routine screening and brief intervention in primary care do not accommodate this reality. Possible responses to enhance AOD conversations within general practice settings are discussed. [ABSTRACT FROM PUBLISHER]

The present paper takes an interactional approach to the problem of communicating pain. We ask how a shared understanding of this subjective and internal experience is accomplished. The focus is on the multimodal features of pain displays and the way they emerge and progress at the micro level of turn construction and sequence organisation within health care interactions. The setting of the study is family doctor-patient primary care consultations. Using multimodal conversation analysis, we show the emergent, temporal unfolding nature of pain displays. Initially there is an embodied reflex-like action where an immediately prior cause can be attributed retrospectively. An interjection or non-lexical vocalization may follow. An expression of stance on the pain is routinely made as talk is resumed. The other party's understanding can be shown early in the pain display shaping its unfolding with empathetic vocalizations and/or comforting touch which results in a jointly produced change in the trajectory of action. The implications of the findings for theoretical understandings of sound objects, language and communication, and for clinical practice, are discussed. • A complex organisation of talk and embodied behaviours construct a display of pain. • Communicating pain is emergent and temporally unfolding. • A display of pain can include a reflex like action, interjections or non-lexical vocalisations and a stance display. • Vocalisations by both doctor and patient are key to communicating pain. • Pain is jointly accomplished via a range of sequentially relevant interactional resources. [ABSTRACT FROM AUTHOR]