Laughter as Medical Providers' Resource: Negotiating Informed Choice in Prenatal Genetic Counseling

Abstract

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.

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

“…Except for Example 1 that comes from the history-taking stage, all other examples come from the educational and the decision-making stages where, as we have previously observed (Zayts and Schnurr 2011), most of these laughter sequences occur.…”

“…As we have discussed in our previous work (e.g. Zayts and Schnurr 2011;Zayts and Pilnick 2014), among the Filipino clients it is not unusual to opt out of testing altogether or to agree to non-invasive and safe testing option due to their Roman Catholic background and the religiously motivated opposition towards termination of pregnancy (which is the only "medical" intervention available to these women if an abnormality is identified).…”

“…We focus here on 34 consultations that we also analyzed in our previous study (Zayts and Schnurr 2011) -albeit with a focus on the nurses' rather than the patients' laughter. These consultations vary in length from 9 to 22 minutes, and the overall recording time is around 7 hours.…”

“…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.…”

“…In our previous work on laughter in PS we have shown that laughter may be employed by nurses to help them achieve the main institutional goal of these interactions, namely facilitating autonomous choice by their clients, i.e. pregnant women, regarding whether they want to take prenatal screening tests or not (Zayts and Schnurr 2011). We have examined two specific contexts in which the nurses' laughter regularly occurs: when the women refuse outright to undergo prenatal screening (which goes against the nurses' beliefs that it is in the women's best interests to take tests and to confirm whether the child they carry has Down's syndrome or not); and when the women address direct questions to the nurses regarding what tests they should take (which interferes with the professional principle of nondirective [or non-intrusive] way of conducting PS consultations).…”