Dew2010

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Dew2010
BibType ARTICLE
Key Dew2010
Author(s) Kevin Dew, Maria Stubbe, Lindsay Macdonald, Anthony Dowell, Elizabeth Plumridge
Title The (non) use of prioritisation protocols by surgeons
Editor(s)
Tag(s) medical EMCA, elective surgery, prioritisation tools, doctor-patient interaction
Publisher
Year 2010
Language
City
Month
Journal Sociology of Health & Illness
Volume 32
Number 4
Pages 545–562
URL Link
DOI 10.1111/j.1467-9566.2009.01229.x
ISBN
Organization
Institution
School
Type
Edition
Series
Howpublished
Book title
Chapter

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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.

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