UCLA

Studies examining US prenatal care have identified problem screening and information giving as the doctor’s main agenda, and receiving information as patients’ main goal, however few studies have examined the interactional practices of prenatal care to determine how physician and patient goals and orientations become manifest in the visit and how they are implemented in practice. This study applies the methods of conversation analysis to 30 prenatal consultations to uncover how patients’ desires, views, and concerns manifest in discussion, and how the doctor navigates the balance between patient concerns and a medical agenda. An analysis of ultrasound introductions shows how the doctor and her patients index a secondary orientation to the ultrasound as a valid means to satisfy patient curiosity, while simultaneously maintaining a primary orientation to the ultrasound as a medical tool. In addition, both parties may exploit patient curiosity as a cover for medical concerns. Examining different points of future decision making reveals that the doctor implicates varying levels of patient agency in determining the course of care. These differing levels of agency appear to vary systematically with the type of decision under discussion, apparently owing to patient experience, professional recommendations, and larger cultural attitudes. Finally, the doctor and patients’ regular use of particular interactional strategies creates an environment in which worry is obscured or circumvented. This allows for the doctor to monitor the patient and share information with her without triggering alarm. Taken together, these chapters help to elucidate how important prenatal care objectives are pursued with due sensitivity to patient interests and concerns.