INTRODUCTION: Internationally, a number of studies have investigated general practitioner (GP) opinion of weight management interventions. To date there have been no similar studies carried out in New Zealand. This study aimed to explore GP opinion of weight management interventions in one region of New Zealand. Understanding GP opinion is important, as rates of obesity are increasing and GPs are front-line health care service providers. The data collected could be used to guide health service development in New Zealand, and to inform training and support of GPs in obesity management. METHODS: A qualitative study using inductive thematic analysis of a series of 12 semi-structured interviews with GPs in the Wellington region of New Zealand. FINDINGS: Five key themes were identified: 1) GP perceptions of what the GP can do; 2) the roots of the obesity problem; 3) why the GP doesn’t succeed; 4) current primary care interventions; and 5) bariatric surgery. CONCLUSION: The GPs interviewed felt responsible for treatment of obesity in their patients. They expressed a sense of disempowerment regarding their ability to carry this out, identifying multiple barriers. These included: a society where overweight is seen as normal; complex situations in which weight management is rooted in personal issues; stigma associated with overweight and its management; lack of efficacious interventions; and low resource availability. Bariatric surgery was viewed cautiously in general, though some examples of positive results were reported, as well as a desire for increased access to this treatment option. KEYWORDS: Body weight change; general practice; obesity; primary health care; therapy

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.

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INTRODUCTION: Effective teamwork in primary care settings is integral to the ongoing health of those with chronic conditions. This study compares patient and health professional perceptions about teams, team membership, and team members’ roles. This study aimed to test both the feasibility of undertaking a collaborative method of enquiry as a means of investigating patient perceptions about teamwork in the context of their current health care, and also to compare and contrast these views with those of their usual health professionals in New Zealand suburban general practice settings. METHODS: Using a qualitative methodology, 10 in-depth interviews with eight informants at two practices were conducted and data analysed using inductive thematic analysis. FINDINGS: The methodology successfully elicited confidential interviews with both patients and the health professionals providing their care. Perceptions of the perceived value of team care and qualities facilitating good teamwork were largely concordant. Patient and health professionals differed in their knowledge and understanding about team roles and current chronic care programmes, and had differing perceptions about health care team leadership. CONCLUSION: This study supports the consensus that team-based care is essential for those with chronic conditions, but suggests important differences between patient and health professional views as to who should be in a health care team and what their respective roles might be in primary care settings. These differences are worthy of further exploration, as a lack of common understanding has the potential to consistently undermine otherwise well-intentioned efforts to achieve best possible health for patients with chronic conditions. KEYWORDS: Primary health care; chronic disease; physicians; nurses; patients; patient care team

A B S T R AC T 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.K E Y W O R D S : conversation analysis, critical discourse analysis, discourse analysis, discursive psychology, interactional sociolinguistics, politeness theory, pragmatics, workplace interaction Any newcomer to the study of conversation or language in use will be bewildered by the array of analytic approaches that exists. Even more seasoned researchers might be challenged to provide comprehensive descriptions of the range of discourse analytic approaches available in disciplines across the humanities and social sciences. These include pragmatics, speech act theory, variation analysis, communication accommodation theory, systemic-functional linguistics, semiotics, proxemics, and various types of rhetorical, stylistic, semantic and narrative analysis. A recent interdisciplinary textbook (Titscher et al., 2000), for example, surveys 12 different approaches to discourse analysis, and even then three of the five approaches adopted in this article are not included. These five approaches to the analysis of spoken interaction will be well known to readers of journals such as this one, but we make no claims for comprehensiveness here. Rather, our aim in this article is to explore the different facets of one particular spoken interaction by providing a detailed discourse analysis of its features from five different analytical perspectives.

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INTRODUCTION Obesity is overtaking tobacco smoking in New Zealand as the leading potentially modifiable risk to health. International obesity guidelines recommend that health professionals opportunistically encourage weight management with their patients. However, research shows consistently low rates of weight management discussion, suggesting that health professionals may not be realising their full potential to address obesity. AIM To identify communication strategies used by General Practitioners (GPs) to open the topic of weight and weight management in routine consultations. METHODS A secondary analysis was conducted of 36 video-recorded consultations in general practices, selected for relevance from a database of 205 consultations. Content and interactional analysis was conducted in the context of the entire consultation. RESULTS The topic of weight was initiated more often by GPs than patients and was raised mostly once or twice in a consultation and occasionally as many as six times. GPs employed opportunistic strategies twice as often as they used structured strategies. DISCUSSION This study of naturally occurring consultations confirmed GPs do engage in opportunistic discussions about weight. However, such discussions are challenging and interactionally delicate. Highlighting the clinical relevance of weight appears to be effective. The high frequency of patient contact with GPs provides opportunity to reach and work with people at risk of chronic conditions associated with excess weight. Further research is required to identify suitable training and brief intervention tools for use in routine consultations that may be beneficial for both GPs and patients.

Little research has been undertaken on the actual decision-making processes in cancer care multidisciplinary meetings (MDMs). This article was based on a qualitative observational study of two regional cancer treatment centers in New Zealand. We audiorecorded 10 meetings in which 106 patient cases were discussed. Members of the meetings categorized cases in varying ways, drew on a range of sources of authority, expressed different value positions, and utilized a variety of strategies to justify their actions. An important dimension of authority was encountered authority-the authority a clinician has because of meeting the patient. The MDM chairperson can play an important role in making explicit the sources of authority being drawn on and the value positions of members to provide more clarity to the decision-making process. Attending to issues of process, authority, and values in MDMs has the potential to improve cancer care decision making and ultimately, health outcomes.