The (non) use of prioritisation protocols by surgeons
journal contributionposted on 2020-07-23, 02:36 authored by Kevin DewKevin Dew, M Stubbe, L Macdonald, A Dowell, E Plumridge
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. © 2010 The Authors. Journal compilation © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.
Preferred citationDew, K., Stubbe, M., Macdonald, L., Dowell, A. & Plumridge, E. (2010). The (non) use of prioritisation protocols by surgeons. Sociology of Health and Illness, 32(4), 545-562. https://doi.org/10.1111/j.1467-9566.2009.01229.x
Journal titleSociology of Health and Illness
Online publication date2010-02-12
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elective surgeryprioritisation toolsdoctor-patient interactionHealth services & systemsGeneric Health RelevanceDecision Support TechniquesElective Surgical ProceduresHumansNew ZealandPatient Care ManagementPhysician-Patient RelationsReferral and ConsultationVideotape RecordingSurgical Procedures, ElectiveScience & TechnologySocial SciencesLife Sciences & BiomedicinePublic, Environmental & Occupational HealthSocial Sciences, BiomedicalSociologyBiomedical Social SciencesCONSULTATIONSPublic HealthPolicy and AdministrationPublic Health and Health ServicesHistory and Philosophy of Specific Fields