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How diagnosis fits within the overall activity structure of surgical consultations remains under-researched. We set out to contribute to this developing area of research with a particular focus on responses to diagnosis as an achievement of patient agency. We identified 26 diagnostic sequences in a collection of 35 video recorded surgical consultations and examined these in detail using conversation analysis. The activity of diagnosis and the transition to treatment recommendation appear to be structured somewhat differently in surgeon-patient consultations than has been reported for primary care settings. In particular, patient responses to diagnosis are more frequent and more likely to be extended. The analysis provides evidence that both parties orient to surgeons' accountability for their own diagnostic reasoning, and also the medical authority of the referring doctor and the subjective experience of the patient. In delivering the diagnosis, the surgeon must be cognizant of the opinions of both the patient and the referring doctor, which may align to a greater or lesser extent with their own diagnosis. [ABSTRACT FROM AUTHOR]

Although information provision is a prerequisite of informed decision making in surgical consultations, research has shown that patients' understanding of such information is often limited. We use conversation analysis to illustrate patients' and surgeons' management of interactivity, intersubjectivity, and progressivity during information provision, which frequently takes the form of extended tellings. In the midtelling phase of extended tellings, the surgeon is the primary speaker and patients orient to the temporary suspension of the usual turn-taking system. On the rare occasions that patients do take the floor midtelling, it is overwhelmingly following surgeons' self-repeats-as-unit-ends, which include gist formulations. We argue that surgeons' self-repeats-as-unit-ends are a practice for encouraging interactivity during extended tellings and as a consequence for facilitating shared understanding of decision-relevant information. Data are in English. [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]

This article deconstructs the conventional definition of bullying through analysis of its historical context, and identifies blind spots using lenses of gender, culture and setting. We explore theoretical and methodological problems associated with the conventional definition and its axiomatic use in bullying research, with particular reference to online bullying. We argue that because children may use ‘bullying’ to mean many different practices not captured in the conventional definition, using this definition often obscures the very phenomena researchers are aiming to describe. As a result, adults risk missing these practices in research and for interventions that use these studies as their evidence base. [ABSTRACT FROM AUTHOR]

The present study investigated emotions as they were made visible and responded to in a particular institutional setting. Following discursive psychology the aim was to provide a rigorous account of emotion as observable in talk-in-interaction. Using conversation analysis a focus was on the temporality of emotion in turns of talk and over the course of an interaction. Data were recordings and transcriptions of calls to a dispute resolution service for consumers' problems with electricity and gas. The analysis identified systematic practices callers' use for describing and doing upset. Call-takers rarely displayed emotion in the body of the calls and typically responded to institutionally relevant aspects of the callers' troubles and not the emotional ones. In the absence of any kind of endorsement of the callers' emotional stance, emotionality could escalate. Emotional affiliation regularly occurred at the end of the calls. The escalation of emotion in the absence of its endorsement and the occurrence of emotional affiliation at call-closing evidences a sequential property of emotion that has been largely overlooked. [ABSTRACT FROM AUTHOR]

This study examines New Zealand GPs' interaction with computers in routine consultations. Twenty-eight video-recorded consultations from 10 GPs were analysed in micro-detail to explore: (i) how doctors divide their time and attention between computer and patient; (ii) the different roles ascribed to the computer; and (iii) how computer use influences the interactional flow of the consultation. All GPs engaged with the computer in some way for at least 20% of each consultation, and on average spent 12% of time totally focussed on the computer. Patterns of use varied; most GPs inputted all or most notes during the consultation, but a few set aside dedicated time afterwards. The computer acted as an additional participant enacting roles like information repository and legitimiser of decisions. Computer use also altered some of the normal 'rules of engagement' between doctor and patient. Long silences and turning away interrupted the smooth flow of conversation, but various 'multitasking' strategies allowed GPs to remain engaged with patients during episodes of computer use (e.g. signposting, online commentary, verbalising while typing, social chat). Conclusions were that use of computers has many benefits but also significantly influences the fine detail of the GP consultation. Doctors must consciously develop strategies to manage this impact. [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: Diabetes is a major health issue for individuals and for health services. There is a considerable literature on the management of diabetes and also on communication in primary care consultations. However, few studies combine these two topics and specifically in relation to nurse communication. This paper describes the nature of nurse-patient communication in diabetes management. Methods: Thirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as part of a larger multi-site study tracking health care interactions between health professionals and patients who were newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the 6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography and interaction analysis. In addition to analysis of the recorded consultations and interviews, the number of consultations for each patient and total time spent with nurses and other health professionals were quantified and compared. Results: This study showed that initial consultations with nurses often incorporated completion of extensive checklists, physical examination, referral to other health professionals and distribution of written material, and were typically longer than consultations with other health professionals. The consultations were driven more by the nurses' clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed that protocols and checklists both help and hinder the communication process. This contradictory outcome was also evident at a health systems level: although organisational targets may have been met, the patient did not always feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed arising from the sheer volume of information exchanged along with a mismatch in expectations. Conclusions: Conscientious nursing work was evident but at times misdirected in terms of optimal use of time. The misalignment of patient expectations and clinical protocols highlights a common dilemma in clinical practice and raises questions about the best ways to balance the needs of individuals with the needs of a health system. Video- recording can be a powerful tool for reflection and peer review. [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]

This paper provides an overview of an interdisciplinary project which draws together sociolinguistic analyses of workplace discourse and recent work in the field of organisational studies. The starting point for this collaboration was a set of questions which arose from attempts to apply the findings of a large-scale sociolinguistic study into workplace language: (i) How can sociolinguistic tools and models generate useful feedback for practitioners and contribute to organisational learning? (ii) How can the understanding researchers have developed of workplace discourse help individuals and teams critically reflect on their own communication practices? (iii) What can the action research process add to our theoretical knowledge about workplace discourse? The authors explore these questions in the context of a number of current issues in the field of organisational studies, including an increasing interest in language and communication; emerging critical perspectives on the notion of competence in workplaces; and debates over the relationships between expert and practitioner knowledges. The concept of ‘reflective practice’ is presented as a framework to address these issues in the evaluation and development of workplace communication. [ABSTRACT FROM AUTHOR]

This article explores the contributions that five different approaches to discourse analysis can make to interpreting and understanding the same piece of data. Conversation analysis, interactional sociolinguistics, politeness theory, critical discourse analysis, and discursive psychology are the approaches chosen for comparison. The data is a nine-minute audio recording of a spontaneous workplace interaction. The analyses are compared, and the theoretical and methodological implications of the different approaches are discussed. [ABSTRACT FROM AUTHOR]

Background: Effective communication is crucial to any doctor-patient consultation, not least in pregnancy where the outcome affects more than one person. While higher levels of patient participation and shared decision making are recognised as desirable, there is little agreement on how best to achieve this. Most previous research in this area is based on reported data such as interviews or surveys and there is a need for more fine-grained analysis of authentic interaction. This study aimed to identify the discourse characteristics and patterns that exemplify effective communication practices in a high-risk ante-natal clinic.Methods: We video-recorded 20 consultations in a high-risk ante-natal clinic in a large New Zealand city with patients attending for the first time. Post-consultation interviews were conducted with the 20 patients and 13 obstetricians involved. Discourse analysis of the transcripts and videos of the consultations was conducted, in conjunction with thematic analysis of interview transcripts.Results: Most patients reported high quality communication and high levels of satisfaction; the detailed consultation analysis revealed a range of features likely to have contributed. On the clinician side, these included clear explanations, acknowledgement of the patient's experience, consideration of patient wishes, and realistic and honest answers to patient questions. On the patient side, these included a high level of engagement with technical aspects of events and procedures, and appropriate questioning of obstetricians.Conclusions: This study has demonstrated the utility of combining direct observation of consultations with data from patient experience interviews to identify specific features of effective communication in routine obstetric ante-natal care. The findings are relevant to improvements needed in obstetric communication identified in the literature, especially in relation to handling psychosocial issues and conveying empathy, and may be useful to inform communication training for obstetricians. The presence of the unborn child may provide an added incentive for parents to develop their own health literacy and to be an active participant in the consultation on behalf of their child. The findings of this study can lay the groundwork for further, more detailed analysis of communication in ante-natal consultations. [ABSTRACT FROM AUTHOR]

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]

• A continuum of positive and negative stances toward vaccination exists on the internet. • Negative stances, including recommendations against vaccination, are common online. • Negative stances are more common on Facebook than YouTube or Google. • Negative stances were readily found despite attempts to minimise web selection bias. Whether to vaccinate or not is currently a hot topic in social discourse. Despite the majority view that childhood vaccination is safe and effective, websites and social media content opposing such vaccination are common. In this study, we searched the internet platforms Google , Facebook and YouTube for childhood vaccine information. We made every attempt to minimise selection bias generated by internet algorithms. We compared the displayed stances of vaccine information retrieved. Most of the information had a clearly stated stance on vaccines or made some sort of recommendation on whether or not to vaccinate. Despite our careful attempt to search comprehensively and systematically for vaccine information with as little bias as possible, this search yielded a sizeable minority of vaccine negative information. This research shows that negative vaccine information persists and is readily accessible online despite algorithm and policy changes in recent years, even when searching in the least biased way possible. It is important that vaccine-promoting entities and agencies continue to make every effort to maximize their presence online so that parents searching the internet to answer the question 'should I vaccinate my child?' continue to receive vaccine positive information. [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]

Abstract: Using a material semiotics methodology, this paper explores the link between diagnostic practices, patient awareness of the body, and biopolitical governance. We collected video and audio recordings of a patient with chest pain involved in three medical interactions (a general practitioner [GP] consultation, an electrocardiogram stress test and a consultation with a cardiologist) in Wellington, New Zealand. Following the work of Annemarie Mol, we argue that each of these diagnostics interactions bring together a range of material and non-material entities that enact the body and disease. Consequently, we note how the diagnostic practices associated with cardiovascular medicine enable and prompt an awareness of the body based on uncertainty, and thus promotes the self-management of cardiac health and risk. This paper illustrates that a material semiotics methodology makes important contributions to the sociology of diagnosis. Firstly, it draws attention to the relationship between humans and material entities in rendering the body intelligible. Secondly, it illustrates that different diagnostic procedures can produce multiple, potentially conflicting, forms of self-awareness. Alongside these practices generating multiplicity, however, are those that presuppose and produce singularity and coherence. We illustrate how the cardiologist “patches” two potentially conflicting diagnoses together in order to provide a sense of coherence to the interactions. Thirdly, material semiotics illustrates how various diagnostic practices can reify risk, and produce bodies that lend themselves to particular forms of governance. [Copyright &y& Elsevier]

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]

This paper reports on the reflections from members of the evaluation team – both allies and service user academics – about a co-produced approach to evaluation of the pilot of a youth-integrated therapies mental health intervention (co-evaluation). The co-evaluation is being facilitated particularly well through numerous service user academics being involved in the evaluation, and the commitment to co-production and active attendance to the responsibilities of allies by allies. However, multiple challenges still exist with significant implications for allyship. These include the need for us to 'deepen our thinking and approaches to best accomplish authentic and effective engagement' (Daya et al., 2020, 300) in support of co-production specific to the context of individual projects, the fluidity of the allyship position and the need for allies to consistently reinforce their commitment in word and in deed to it. We have also identified the need to acknowledge and respect the distinction between people in roles who happen to have experience and people in roles because they have experience. [ABSTRACT FROM AUTHOR]

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]

The objective of this qualitative study in New Zealand was to investigate how general practitioners and patients discuss chronic pain in consultations. Chronic pain is a complex condition that defies many commonsense understandings. It is challenging to manage and patients can come to conclude that there is an empathy deficit. To our knowledge most, if not all, studies on this topic have recruited participants whose main presenting complaint is chronic pain. Forms of chronic pain are relatively common in the population and we thought it likely that at least some discussions may be rendered invisible via these recruiting practices. The study analysed data from the Applied Research on Communication in Health repository of audio transcripts and video‐recorded consultations collected from a range of studies on a variety of topics, none of which were about chronic pain specifically. We searched the 256 transcripts looking for key words that might indicate that pain was at least part of the consultation. This yielded a large number of potentially relevant transcripts. These transcripts were assessed and reduced to 18 by excluding those that were about non‐physical pain or pain that was expected to resolve relatively quickly. A medical specialist in chronic pain reviewed the resulting 18 and excluded two further transcripts giving us a final sample of 16. We conducted in‐depth analysis of these consultations. Rather than confirming an empathy deficit, we found a much more complex deployment of empathy in the space where the two complex systems of chronic pain and general practice meet. These findings highlight the utility of analysing data originally generated for other purposes, with permission, and in a practical sense, highlight the importance of understanding empathy as highly contextual in 'real world' practice. [ABSTRACT FROM AUTHOR]

Young people born with variations in sex characteristics (VSC) or disorders of sex development (DSD) face numerous challenges in navigating issues relating to identity and to their lived and embodied experience. There is limited published research amplifying the voices of young people with a VSC, especially from Aotearoa/New Zealand. This qualitative study provides an up-to-date picture of the lived experience of 10 young people with a VSC in Aotearoa/New Zealand. The research was conducted in collaboration with the advocacy group, Intersex Youth Aotearoa, and explored the level of support provided by health services, peers and advocacy groups in relation to the ways the participants viewed themselves and their bodies, and their health related decision-making. Findings reveal the pressure on young people with a VSC to conform to cultural and societal norms, specifically, heteronormative and traditional constructs of how male and female bodies should look in Aotearoa/NZ society. Such views, often held and perpetuated by health professionals and parents, contributed to complexities surrounding identity, agency and acceptance of difference experienced by these young people. The implications of these findings are discussed, including the need for better psychological and peer support for young people. [ABSTRACT FROM AUTHOR]

Background: Effective clinical handover has always been integral to delivering safe, high‐quality care in medical wards. Aim: As handover activity increases in importance we wanted to explore the experience of physicians and trainee doctors. There is little research on internal medicine handover with even less based on direct observational research. Methods: Data collection over 4 months by two general medicine physicians included participant observation of 37 meetings and 52 audio‐recorded individual interviews. Inductive thematic analysis of the transcribed interviews proceeded iteratively in parallel with data collection. Results: There was an excellent response rate from 27 of 28 invited trainees and 25 of 26 invited physicians. Overall the experience was positive. Acute medicine handover is a complex human endeavour, occurring daily with an unpredictable workload and areas of tension. Themes were grouped as structural (leadership role, start time, sequence, checklist, handbacks and efficiency) and relational (sensitivity, collegiality, acknowledgement, performance anxiety, tension, responsibility and leadership style). The physician leader needs to be skilled to follow the agreed and evolving process as well as being prepared, authoritative, flexible, equitable, aware and sensitive to the needs of senior colleagues and trainees. There was a tension between efficiency and teaching opportunities. Conclusion: This paper adds to a contextually sensitive understanding of the social dynamics of handover in acute medicine. Addressing the structural aspects is important to provide the necessary consistency and efficiency in what is an extremely complex and time‐sensitive environment. As we continue to work on the evolution of the handover process in acute internal medicine, we must also attend to the relational aspects which are dynamic and central to its sustainability. [ABSTRACT FROM AUTHOR]

Over the last decade, there has been increasing interest in the use of metaphor in cognitive behaviour therapy. However, to date, there has been only very limited research on the use of metaphor in CBT sessions, and no studies which have examined how to train therapists in this skill. The present study is the first in the literature to explore how we might train therapists in metaphor-enhanced CBT. Twelve therapists attended two half-day training workshops, 2 weeks apart. Details of the content of the training workshop are provided. The therapists rated the workshop quality and provided structured self-report ratings and reflections on their ongoing application of learning over a 3-month period which were compared with pre-training ratings. Therapists reported significantly increased awareness of metaphors, with increased confidence in responding intentionally to client metaphors and bringing them into shared conceptualizations. In addition, there were significant increases in reported time spent elaborating on client metaphors, and use of metaphors when conceptualizing with clients. Barriers and solutions to application of learning are discussed. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest in the use of metaphor in cognitive behaviour therapy. Experts advocate bringing client metaphors into case conceptualizations, but there is little empirical research to support this. Aims: This study evaluated the effect of training 12 therapists to attend to client metaphors and bring them into case conceptualizations. Method: Pre- and post-training role-played therapy sessions were conducted and video-recorded. Alliance was rated by role play ‘clients’ and an external expert rated the quality of the sessions and of the shared conceptualizations. Results: There were significant increases in some ratings of alliance, based on role play ‘client’ ratings and external ratings of role plays of therapy sessions before and after training. The greater the difference between therapist and ‘client’ on a measure of preference for producing metaphor, the lower the rating of the session by the ‘client’ on the Bond factor score of an alliance measure, the Working Alliance Inventory. This result suggests that working metaphorically may be most effective when the therapist and client have a similar degree of preference for speaking metaphorically. Conclusion: This study provides preliminary support for the idea that attending to client metaphors during conceptualization can be beneficial for alliance. [ABSTRACT FROM PUBLISHER]

Background: Gout is the most common form of inflammatory arthritis and is associated with considerable co-morbidity. It is usually managed in the primary care setting with a combination of lifestyle modification and pharmacological therapy. This study describes patterns of communication about gout observed in interactions between patients and primary care practitioners during routine consultations. Methods: Secondary analysis of video-recordings of individual healthcare consultations between patients and a range of primary care practitioners (including general practitioners, practice nurses, podiatrists and dietitians) from an archived database. Consultations that included any discussion about gout were eligible for inclusion (n = 31) and were not restricted to those where gout was the main presenting complaint. The consultation transcripts were analysed using a qualitative inductive approach from clinical and linguistic perspectives and supplemented with visual observation of the interactions. Results: Two main themes emerged from the data; the importance of gout and 'telling' versus 'listening' in consultations. The first theme had two distinct strands; gout as an incidental part of the consultation and the impact of gout on patients. A trend towards more didactic practitioner communication encompassed by the second theme occurred at many different consultation points including diagnosis, in more general post-diagnosis discussion, and when discussing biochemical test results and lifestyle advice. In contrast, when discussion about treatment with medicines occurred a tendency towards a greater degree of listening to patients was observed. Conclusion: Our observation of the communication patterns in these consultations illustrates an inherent complexity of gout consultations in primary care. Gout may be more important to patients than is often apparent to practitioners in routine consultations. Consultation management needs to take into account the impact of the condition and the balance of information provided around lifestyle advice versus long-term management with medicines. [ABSTRACT FROM AUTHOR]

Family members continue to be used as interpreters in medical consultations despite the well-known risks. This paper examines participant perceptions of this practice in three New Zealand clinics chosen for their frequent use of interpreters and their skill in using them. It is based on a detailed study of 17 video-recorded interpreted consultations and 48 post-consultation interviews with participants (5 doctors, 16 patients and 12 interpreters, including 6 family members). All participants expressed satisfaction with the communication. Analysis of the interviews explored what participants liked or valued about family member interpreters (FMIs). Key themes were the FMIs' personal relationship and knowledge, patient comfort, trust, cultural norms, time efficiency and continued help outside the consultation. General practitioners (GPs) expressed awareness of potential risks and how to manage them, in contrast to patients and FMIs. Although the use of professional interpreters needs to be strongly promoted, a well-informed decision to use a family member is appropriate in some situations. GPs need to be well trained in how to assess and manage the risks. Rather than striving for 'best practice' (i.e. universal use of professional interpreters), it is better to aim for 'good practice' where a considered judgement is made about each situation on an individual basis. [ABSTRACT FROM AUTHOR]

Research ethics guidelines grew out of several infamous episodes where research subjects were exploited. There is significant international synchronization of guidelines. However, indigenous groups in New Zealand, Canada and Australia have criticized these guidelines as being inadequate for research involving indigenous people and have developed guidelines from their own cultural perspectives. Whilst traditional research ethics guidelines place a lot of emphasis on informed consent, these indigenous guidelines put much greater emphasis on interdependence and trust. This article argues that traditional guidelines are premised on relationships of equal power, and that often the researcher has more power that is not fully equalized by providing information. Where there is a relationship of unequal power, then focusing on interdependence and trust is more likely to achieve ethical safety. We illustrate this thesis by describing the detail of a research project looking at the use of interpreters, where we video-recorded live consultations and then interviewed the patient, interpreter and doctor. We conclude by suggesting that mainstream research ethics guidelines should pay more attention to the development of a trustworthy relationship between subject and researcher, and that, following the lead from clinical medicine, we should develop a culturally competent ethical framework for research on human subjects. [ABSTRACT FROM AUTHOR]

This study uses conversation analysis to explore 'candidate obstacles', a practice observed in sequences of patient resistance to lifestyle advice within health professional consultations. This article presents illustrative analyses of selected data excerpts drawn from audio-visual recordings of 116 tracked consultations between health professionals and 34 patients newly diagnosed with type 2 diabetes mellitus in New Zealand. The analysis shows that in consultations where health promotion activities are central, patient resistance can provide space for patients to identify obstacles to their compliance with lifestyle advice. Identifying candidate obstacles provides opportunities for health professionals to align advice with concerns of patients and potentially improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Metaphors are common in psychotherapy and have potential to enhance therapy in numerous ways. However, the empirical study of metaphors in cognitive behaviour therapy (CBT) has tended to be put in the “too hard basket”, confined to being part of the art rather than the science of therapy. The lack of research is largely due to problems with definition, lack of a consistent, reliable approach to metaphor identification and the challenges of finding appropriate methodology to study this language-based activity. Aims: This study aimed to assess the frequency of metaphors in CBT in a large sample of therapy sessions and to evaluate the reliability and utility of the discourse dynamics approach to metaphor identification. Method: The discourse dynamics approach, recently developed by linguists, was used to identify metaphors in 48 CBT session transcripts (from 12 clients and 3 therapists) and the reliability of this approach was evaluated, using an independent rater. Results: The total frequency of metaphors was 31.5 (range 17–49) per 1000 words of therapy conversation. Therapists produced metaphors twice as often (21.2, range 7–36) as clients (10.3, range 3–24). Reliability of the Discourse Dynamics approach was adequate. Conclusions: Metaphors clearly occur in CBT sessions, with therapists using them at a higher rate than clients. While Discourse Dynamics is currently the most detailed identification approach available for investigating metaphor in CBT sessions, it is challenging to acquire skill in it and we found only adequate reliability. Ways to improve reliability and future research possibilities are discussed. [ABSTRACT FROM PUBLISHER]

Background: We designed and validated a rule-based expert system to identify influenza like illness (ILI) from routinely recorded general practice clinical narrative to aid a larger retrospective research study into the impact of the 2009 influenza pandemic in New Zealand.Methods: Rules were assessed using pattern matching heuristics on routine clinical narrative. The system was trained using data from 623 clinical encounters and validated using a clinical expert as a gold standard against a mutually exclusive set of 901 records.Results: We calculated a 98.2 % specificity and 90.2 % sensitivity across an ILI incidence of 12.4 % measured against clinical expert classification. Peak problem list identification of ILI by clinical coding in any month was 9.2 % of all detected ILI presentations. Our system addressed an unusual problem domain for clinical narrative classification; using notational, unstructured, clinician entered information in a community care setting. It performed well compared with other approaches and domains. It has potential applications in real-time surveillance of disease, and in assisted problem list coding for clinicians.Conclusions: Our system identified ILI presentation with sufficient accuracy for use at a population level in the wider research study. The peak coding of 9.2 % illustrated the need for automated coding of unstructured narrative in our study. [ABSTRACT FROM AUTHOR]

Attention to client metaphors has been asserted as a way of enhancing cognitive behaviour therapy. Metaphors can be part of the shared language that is co-constructed between clients and therapists. Recent advances in cognitive linguistics have provided the most clearly operationalized method yet to identify metaphors in conversations, allowing analysis of how shared language develops. This study aims to explore how metaphoric shared language develops in early cognitive behaviour therapy sessions. Based on 12 transcripts of early cognitive behaviour therapy sessions, an iterative process led to the identification of a range of therapist and client responses to each other’s metaphors, and identification of whether therapists or clients initiated metaphoric exchanges. Types of responses to therapist or client metaphors within three speaking turns were found to be: repetition, rephrasing, exploration, elaboration/extension, or agreement. Bursts of metaphoric exchange were initiated and taken up by therapists and clients at a similar rate. To conclude, therapists need to attend to the occurrence of metaphors and be aware of the range of potential responses that can engage the client in the ‘metaphoric dance’ (co-construction of shared metaphors). This has the potential to enhance engagement and outcomes though more salient reformulating of the problem for the client. [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 consultations.Setting: 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 AUTHOR]

Drawing on Politeness Theory and the Community of Practice model, we examine the uses and functions of the expletive fuck in interaction between workers in a New Zealand soap factory work team. The factory team was extensively recorded in their daily interactions to obtain a corpus of 35 h of authentic workplace talk from which a small number of paradigmatic interactions are selected for discussion in this paper. Particular attention is given to the way in which the expletive fuck is used in two face threatening speech acts, direct complaints and refusals, and its contrasting function in the speech act of whingeing. The analysis focuses on the complex socio-pragmatic functions of fuck and its role as an indicator of membership in a specific community of practice. [Copyright &y& Elsevier]