“It's Just a Likelihood”: Uncertainty as Topic and Resource in Conveying “Positive” Results in an Antenatal Screening Clinic

Abstract

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...

“Something Extra on Chromosome 5”: Parents’ Understanding of Positive Prenatal Chromosomal Microarray Analysis (CMA) Results

“…(Bernhardt et al 2014; Mikhaelian et al 2013) Participants in this study described provider messages of reassurance, particularly with inherited CNVs. When faced with results of uncertain significance, providers frequently tell patients there may be nothing to worry about (Pilnick & Zayts 2014), and patients are likely to interpret and act on providers’ preferences (Muller & Cameron 2015). We hypothesize providers may focus less on unknown or potential risks and instead seek to reassure parents who have expressed their desire to continue with a pregnancy.…”

5. Laughter as a “serious business”: Clients’ laughter in prenatal screening for Down’s syndrome

“…We have applied conversation analysis to analyzing PS encounters in our previous work (e.g. Zayts and Schnurr 2011;Zayts and Pilnick 2014;Pilnick and Zayts 2014) and have noted that the advantage of this methodology is on the close attention to the processes involved in PS, for example, examining not only whether autonomous choice by the clients has been achieved but also how it has been achieved. Our analysis of the interactional data is also ethnographically informed.…”

“…miscarriage]), the "risk of knowing" (psychosocial and interpersonal implications that finding out about abnormalities via testing may have on a client and the family) (Sarangi et al 2003), and the "risk of not knowing" (psychosocial implications of not pursuing any testing [e.g. increased anxiety]) (see also Pilnick and Zayts 2014;Yau and Zayts 2014). Naturally, this relatively high amount of risk talk may easily lead to a heightened anxiety among the clients that may be both explicitly lexicalized by them (e.g.…”

“…Even when the professionals choose to direct their clients in the decision-making towards the options that they (the professionals) favor, this is done in more covert ways by, for example, giving recommendations, listing out (preferred) testing options, or foregrounding specific psychosocial concerns (e.g. these women's worries) as the basis for the decision to undertake a specific test (see also Pilnick and Zayts 2014). In our last two examples we examine how participants employ laughter as another "covert" strategy of negotiating their deontic authority.…”

Contesting and Differentially Constructing Uncertainty: Negotiations of Contraceptive Use in the Clinical Encounter

“…Some of the earliest research on medical uncertainty focused on the strategies that medical students and providers used to manage uncertainty (Fox 1957; Light 1979). Research has since expanded to examine the psycho-social effects of uncertainty on medical providers (Cranley et al 2012; Gerrity et al 1992) and has examined the ways that patients and doctors grapple with tests (like genetic screenings) that deal with uncertain information (Pilnick and Zayts 2014; Timmermans and Buchbinder 2010). While research in both medicine (Beresford 1991; Cristancho et al 2013; Dalton et al 2015; Farnan et al 2008; Ringsberg and Krantz 2006) and sociology (Rafalovich 2005; Whooley 2010) documents the effect of uncertainty on clinical decision-making, the literature focuses much less on how medical providers construct knowledge for patients amid uncertainty.…”