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.