Management of risk vis-à-vis responsibility in telephone-mediated consultations for a genetic condition : a discourse analytic study

Abstract

In Hong Kong, all newborn infants in public hospitals are routinely screened for a mild hereditary disorder, G6PD deficiency (commonly known as favism). Parents whose infants are diagnosed with the condition are informed about it via telephone by genetic nurses at a specialised genetic counselling and testing clinic. This condition is life-long although adherence to certain lifestyle practices (including the avoidance of some medicines, food and chemicals) ensures a normal life for the affected individuals.

The aim of this thesis is to investigate how the notions of risk and responsibility are interactionally manifest in telephone consultations between genetic nurses and mothers of infants with G6PD deficiency. The study assumes that the fact that this is a manageable genetic condition, the mode of communication, and the mechanism of participation will have an impact on how the discourse of responsible risk management unfolds in interaction.

The data comprise forty eight audio-recorded telephone consultations collected in a specialised clinic in Hong Kong during 2011-2013. The analytic framework chosen is activity analysis, based on the notions of activity types (Levinson, 1992) and discourse types (Sarangi, 2000). The analysis includes three types of mapping – structural mapping, interactional mapping and thematic mapping – which are useful for identifying phases of the consultations, participation and role and the trajectories of responsible risk management.

Detailed analysis shows that the discourses of risk and responsibility are manifest through the discourse types of explanation giving and advice giving. Firstly, four main types of risk talk vis-à-vis explanation giving are discussed in terms of their structural (hereditary risk talk typically occurs after physiological risk talk) and interactional distribution and respective functions; namely informative, educational, reassuring and warranting for advice. Secondly, parental responsibility is communicated in terms of self/other-oriented actions in risk prevention. The construction of different types of parental responsible action is manifest through explanation giving and advice giving. Mothers are constructed as primary carers, taking certain actions themselves while discharging responsibility among the medical professionals, other family members and the child both as infant and when older. The findings also show that the discourse types of advice giving and explanation giving serve to provide reassurance to parents.

The analysis discusses how this interplay of risk, responsibility, explanation giving and advice giving reflects the specific characteristics of a telephone-mediated consultation including the ways of eliciting the mothers’ existing knowledge and addressing their concerns when visual cues are absent. These findings may raise professionals’ awareness of the issues concerning the most effective delivery of information or advice in order to accomplish the ultimate goal of this encounter which is to prevent the fatal complications of G6PD deficiency.