When protagonists mobilise frames difficult to concile
It is not rare for protagonists to approach a consultation using
different frames. Such situations tend to rigidify interactions and
sometimes lead to distortions likely to hinder the decision-making
process.
When engaged in the medical authority frame, women do not expect a
general explanation of pregnancy risks but the practitioner’s opinion of
their personal situation. Above all, they seek reassurance and/or
guidance. The medico-scientific expertise frame, which orients the
practitioner’s attitude, and the medical authority frame which directs
that of the women, thus enter into opposition. Waiting for an opinion on
her personal situation that does not come, the woman may start to think
that the technical information she is receiving is a prelude to the
announcement of bad news. The length of time it takes to provide this
information increases her distress further. In France, after quietly
listening to the midwife explain the way DS screening works, receiving
information on the pathology, with photos of children with the syndrome,
a woman, of African origin, begins to cry and her partner, who can no
longer keep quiet, interrupts the midwife: “Excuse me, but does
this concern us?”.
The tension caused by the confrontation between the two frames generally
leads to a high emotional charge that hinders the fluidity of the
interactions. It can nevertheless be reduced by exposing the gap between
the woman’s expectations and the demands of the medico-scientific
expertise frame. This is what the midwife attempts to do when she begins
her consultation with a preamble destined to reassure the couple:“The first thing we need to be clear on is that baby might be
absolutely normal, OK? This is a risk assessment ” (Midwife, England).
However, the concept of risk is not always well understood and the
preamble not always enough to contain emotions. These situations have
different outcomes. The decision might be postponed and a new
appointment made, as is often the case in France. The woman might also
choose to have the sample taken as a way of resolving the distress
caused by the expert discourse.
The women/couples who approach pregnancy and its monitoring through the
frame of religious authority do not begin consultations with the
intention of gathering information that will help them to make a
decision. Their decision has already been made. Yet they are rarely
given the opportunity to express their position from the outset and some
women feel that they do not have the legitimacy to interrupt the
practitioner and assert their point of view. As for the practitioner,
providing neutral, objective scientific and technical information is a
regulatory duty. Practitioners must obtain signed consent from women
before taking a sample. As they do not know how their colleagues
informed the patient, or how the information had been understood, they
repeat the entire content. When the opinion is based on
medico-scientific expertise, there is no major problem. However, when
the decision (not to have a sample taken) has been made in the religious
authority frame, the situation is very different. The practitioner’s
pursuit of his/her role to inform can be interpreted as a lack of
respect, as the invalidation of the couple’s point of view, a way of
asserting that only medico-scientific expertise can legitimately form
the basis for a decision. Again, the length of time taken to provide the
information tends to increase the emotional charge which then translates
into mistrust and resentment, and which can lead to an obstinate silence
or, sometimes, definitive remarks: “Doctors don’t know anything;
only God knows” (France). This consultation configuration does not
provide the conditions required for fluid interactions. The tension can
sometimes be resolved when the content of the interactions shifts
towards the routine monitoring of the pregnancy. It can reach a peak
when the practitioner looks to protect him/herself from any legal action
by noting in the medical file that the woman, after receiving all of the
required information, refuses to undergo a diagnostic examination.