title: 'What do you think?' the collaborative practices of choice and care in a Danish obstetric ultrasound unit.
abstract: This paper is based on ethnographic fieldwork at an obstetric ultrasound unit in Denmark and explores the few, intense minutes of clinical interaction following a high-risk screening result for Down's syndrome. The category of high-risk transforms the routine ultrasound into a situation of inescapable choice, where the health of the foetus is questioned and decisions must be made. The clinical interactions following a high-risk result are investigated as processes of production, and the concepts of logic of choice and the logic of care are employed as analytical tools for identifying different rationales at play in the situation. The analysis shows that sonographers and women/couples collaboratively engage in logics of choice and care. Their mutual aim is to make the high-risk results meaningful and manageable so that a decision can be made. In this process initiative is shifted back and forth. Through a logic of care, complexity is reduced and statistics transformed by emphasising certain interpretations and leaving others unspoken. However, the logic of choice is also collectively maintained by positioning the women/couples as decision-makers. It is argued that in the obstetric ultrasound unit, the logic of choice provides a powerful frame, with the logic of care filling in the gaps and discontinuities to facilitate decisions. In this context, the logics are complementary rather than competing, and thus the analysis add new perspectives to the original concepts. In sum, the logics of choice and care provide a valuable analytical tool for interpreting and understanding the complex and collaborative practices of clinical interaction.
authors.affiliation: a CFK - Public Health & Quality Improvement, Central Denmark Region, Olof Palmes Alle 15 , 8200 Aarhus N, Denmark, and Institute of Public Health, Aarhus University, Olof Plames Alle 15 , 8200 Aarhus N , Denmark.
authors.forename: Stina
authors.initials: S
authors.lastname: Lou
authors.affiliation: a CFK - Public Health & Quality Improvement, Central Denmark Region, Olof Palmes Alle 15 , 8200 Aarhus N, Denmark, and Institute of Public Health, Aarhus University, Olof Plames Alle 15 , 8200 Aarhus N , Denmark.
authors.forename: Camilla Palmhøj
authors.initials: CP
authors.lastname: Nielsen
authors.affiliation: b Department of Obstetrics and Gynaecology , Aarhus University Hospital Skejby , Skejbygaardvej 100, 8200 Aarhus N , Denmark.
authors.forename: Lone
authors.initials: L
authors.lastname: Hvidman
authors.affiliation: b Department of Obstetrics and Gynaecology , Aarhus University Hospital Skejby , Skejbygaardvej 100, 8200 Aarhus N , Denmark.
authors.forename: Olav Bjørn
authors.initials: OB
authors.lastname: Petersen
authors.affiliation: c General Practice Research Unit , Institute of Community Medicine, University of Tromsø , 9037 Tromsø , Norway.
authors.forename: Mette Bech
authors.initials: MB
authors.lastname: Risør
mesh_terms: D001291:Attitude of Health Personnel; D002755:Choice Behavior; D003718:Denmark / Q000208:ethnology; D005260:Female; D006801:Humans; D011247:Pregnancy; D012306:Risk; D016216:Ultrasonography, Prenatal
keywords: clinical encounter; decision-making; prenatal screening; risk