Merging doctor and client knowledge: On doctors’ ways of dealing with clients’ potentially discrepant information in genetic counseling

An important part of genetic counseling is the delivery of specialized expert knowledge by professionals. However, clients of these professionals have knowledge as well. Using video-recorded sessions of genetic counseling in Finland as data, the article examines a specific interactional position in which doctors’ knowledge and clients’ knowledge are managed, namely, the doctor's response to a presentation of potentially discrepant information by a client during information delivery. The article concentrates particularly on cases where the doctor accepts the client's information as such, but shows that it is not really discrepant with her own information. Three ways in which doctors merge the two pieces of knowledge are described: organizing knowledge into a coherent whole, offering evidence for their original information, and attributing causes to their clients’ information. An exceptional case, in which a doctor has to deal with uncertainty and resistance, is also analyzed. In their responses the doctors achieve a delicate balance between acknowledging the client's knowledgeability and reinstituting their expertise. They also seem to be managing many other tasks such as answering questions, producing second assessments, offering reassurance, and minimizing threats to solidarity. The primary method adopted for the present study is ethnomethodological conversation analysis.