The (non) use of prioritisation protocols by surgeons.
Kevin Dew1, Maria Stubbe, Lindsay Macdonald
1Sociology Programme, Victoria University of Wellington, Wellington 6140, New Zealand. Kevin.dew@vuw.ac.nz
Sociology of Health & Illness
|February 19, 2010
Summary
Surgeons in New Zealand do not explicitly use clinical priority assessment criteria (CPAC) tools during consultations. The complex interaction of delivering diagnoses and treatment plans, akin to news delivery, hinders protocol adherence and impacts health policy goals.
Area of Science:
- Health Policy
- Medical Sociology
- Clinical Communication
Background:
- Priority setting and rationing are central to modern health policy.
- Clinical Priority Assessment Criteria (CPAC) tools aim to improve equity and efficiency in accessing elective surgery in New Zealand.
Purpose of the Study:
- To investigate how surgeons utilize CPAC tools within patient consultations.
- To understand the practical application of health policy tools in clinical settings.
Main Methods:
- Video and audio recordings of 47 consultations involving 15 surgeons.
- Analysis using conversation analysis methodology.
- Application of Maynard's concept of news delivery.
Main Results:
- CPAC tools were not explicitly observed being used in any recorded consultations.
- The delivery of diagnoses and treatment plans functions as 'news delivery' (good or bad news).
- Interactional demands of news delivery challenge the consistent use of protocols like CPAC.
Conclusions:
- The practical use of clinical protocols like CPAC is impeded by the inherent interactional complexities of patient consultations.
- Designing interventions to influence clinician behavior requires a deeper understanding of consultation dynamics.
- Addressing the interactional demands of clinical communication is crucial for achieving health policy objectives.