This is just a probability: the interactional management of uncertainty in conveying ‘positive’ results in an antenatal screening clinic

Abstract

Over the last 20 years, antenatal screening has been the target of considerable sociological scrutiny (Reid et al, 2009). This work is largely interview-based, and uncertainty is a key theme arising from women’s accounts. Given the limitations of current screening tests (Meier et al 2002), pregnant women and clinic personnel potentially face a double uncertainty: not only do screening tests produce uncertain answers, but those results themselves are also of uncertain reliability. However, little is known about how these issues are raised, discussed and negotiated in actual consultations. In this paper we use conversation analysis to examine 18 consultations collected from one public hospital in Hong Kong. The women in these consultations have previously undergone screening tests for fetal abnormalities, and their results fall outside of the ‘normal’ range set by the clinic, so that in official terms they have all ‘screened positive’. The purpose of the consultations examined here is to convey these results and offer options for further diagnostic testing. We examine the ways in which the ‘positive’ test results are conveyed to the women. We demonstrate that results are both quantitatively constructed through use of numeric probabilities and risk factors, but also qualitatively described through use of terms such as ‘high risk’ , or ‘not so serious’, and show how these latter descriptions are not always objectively derivable from the results themselves. We also consider the ways in which uncertainty -both in relation to the results and in relation to the tests themselves- is formulated and discussed.