The recognition of uncertainty as a pivotal issue for the sociology of medicine is longstanding. More recently, the widespread integration of new medical technologies into healthcare has led to a renewed analytic focus on uncertainty. However, there remains little work on the interactional manifestations of uncertainty. This article uses conversation analysis to examine how uncertainty is introduced and used in one specific setting: an antenatal screening clinic in Hong Kong. We focus on women who have received ''screen positive'' or higher risk results, and reflect on the ways in which uncertainty is an ''essential tension '' (Mazeland and ten Have 1996) in the activity of conveying these results to them. We conclude that as well as posing potential difficulties for interaction, the uncertainty of test results is also used here as an interactional resource in managing the institutionally defined category of ''high risk.''Keywords: uncertainty, risk communication, conversation analysis, antenatal screening, ''screen positive'' (high risk) patients, diagnosis delivery INTRODUCTIONThe recognition of uncertainty as a pivotal issue for the sociology of medicine is longstanding. As Davis (1960) notes, the identification of its importance can be traced back to Parsons (1951), who describes it as a primary source of strain in the doctor's role. This strain arises for two reasons: not only does it obscure definitive diagnoses and prognoses, but it also poses major issues for doctor/patient communication. In her analysis of how medical students are socialized, Fox (1957) distinguishes two aspects of uncertainty: the limitations of medical knowledge itself, and the limitations of any one individual's mastery of that knowledge. In other words, ''functional'' uncertainty). Davis notes that the uncertainty in this latter case may be either real or pretend, but invoking it serves a function for the clinician, for example, in promoting a particular course of action or treatment. He argues that doctors, as a matter of professional obligation, routinely seek to narrow the range of uncertainty for the patients they deal with.More recently, the increased integration of new medical technologies into healthcare has led to a renewed analytic focus on uncertainty. More recent work by Fox (1980Fox ( , 2000 has gone so far as to argue that as technologies increase our ability to test and measure, the lack of clarity over what such results should be taken to signify means that uncertainty is becoming the hallmark of medicine. The consequences of this for patients has been speculated upon, with Timmermans and Angell (2001:356) suggesting that a perceived inadequacy of evidence might in fact lead to a greater validation of ''humanistic concerns,'' concentrating the focus on what is best in the context of a particular patient's circumstances. They also, however, cite the view of Katz (1984), a psychiatrist who argues that propelled by uncertainty, the pendulum has swung too far in the opposite direction, and that strategies doctors have...

There now exists a considerable body of sociological work examining antenatal screening for fetal abnormalities. A common theme emerging from this literature is that pregnant women report not feeling able to exercise choice freely, experiencing constraints both from medical professionals and their perceived expectations of the sociocultures in which they live. This study adds to existing literature in three ways. Firstly, in contrast to the existing body of interview-based research, the study uses video recordings of actual consultations, in order to capture the interactional processes through which choice and constraints are established, negotiated and contested. Secondly, it explores the next stage in the process of antenatal screening, by focusing on women who are offered invasive diagnostic testing as a result of 'high risk' screening results, and who have been the subject of little research. Thirdly, the study site in Hong Kong provides a particularly interesting location, given limited research on antenatal screening in that part of the world, and Hong Kong's cosmopolitan environment that is reflected in the diversity of client population undergoing antenatal screening. Using conversation analysis we examine how aspects of the clients' diverse socioeconomic backgrounds and circumstances are interactionally managed in this setting, and how this might impact on decision-making.

A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. AbstractShared decision making has been widely advocated across many branches of healthcare, yet there is considerable debate over both its practical application and how it should be examined or assessed. More recent discussions of SDM have highlighted the important of context, both internal and external to the consultation, with a recognition that decisions cannot be

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This article illustrates some of the ways in which the notion of (paid) work is actively being gendered, and how these gendering processes take place not only through organizational practices but also in discourses that circulate outside an organization in the private domain. Drawing on 15 in‐depth interviews with women who opted out of their own professional career in order to accompany their husbands on their overseas work assignment to Hong Kong, we demonstrate some of the benefits of using a discourse analytical approach to capturing and identifying the processes through which these women actively (although not necessarily consciously) gender the notion of work, thereby reinforcing the gender order and its male bias. We argue that identifying and making visible these gendered and gendering practices is an important component of, and a potential trigger for, change both in organizations as well as private contexts.

This paper aims to challenge the perception that in medical encounters laughter is an interactional resource primarily employed by patients. Drawing on 34 video-recorded prenatal genetic counseling (PGC) sessions collected in a Hong Kong hospital, and combining quantitative and qualitative methods, we illustrate that laughter is in fact frequently employed by the medical providers in our data. The particular focus of the paper is on the ways in which laughter initiated by the medical providers assists interlocutors in negotiating informed choice, a crucial aspect of PGC sessions.Findings indicate that laughter initiated by the medical providers performs at least two PGC-specific functions: it assists the medical providers in "laughing off" and overcoming patients' resistance, and it helps them in dealing with patients' direct questions. Laughter is thus an important resource for the medical providers in pursuing the institutional goals of the interaction, namely negotiating informed choice with their patients.

Original citation:Schnurr, Stephanie and Zayts, Olga. (2013) "I can't remember them ever not doing what I tell them!": Negotiating face and power relations in 'upward' refusals in multicultural workplaces in Hong Kong. Intercultural Pragmatics, Volume 10 (Number 4). pp. 593-616. Permanent WRAP url: http://wrap.warwick.ac.uk/58723 Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work of researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-forprofit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. Publisher's statement:The final publication is available at www.degruyter.com http://dx.doi.org/10.1515/ip-2013-0028 A note on versions: The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRAP url' above for details on accessing the published version and note that access may require a subscription. Despite abundant research on refusals in a variety of contexts across cultures, there are very few studies of multicultural workplaces. This is particularly surprising considering that refusals have been described as a frequent " 'sticking point' in cross-cultural communication" (Beebe et al. 1990). This paper addresses this gap by drawing on more than 80 hours of authentic audio-and videorecorded spoken workplace discourse and a corpus of emails collected in multicultural workplaces in Hong Kong.Findings of this exploratory study indicate that refusals are complex communicative activities that are carefully negotiated among participants. We argue that in contrast to earlier studies, participants' socio-cultural backgrounds do not appear to be the main determining factor of how issues of face and power relations are negotiated in upward refusals. Rather, a range of other factors, including media of communication, normative ways of interacting in a workplace, the relationship between interlocutors, as well as the content of the refusal, are more relevant for explaining participants' communicative behavior.

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