Biomedical Engineering Reference
In-Depth Information
In the
everyday life of the patient
, understandings of normality are
embedded in the everyday knowledge that is constantly negotiated and
developed in the interface between the expert and everyday world. One
the one hand, empirical studies indicate that people seem to rely on the
various notions of normality that are found in clinical practice; normality
as the typical, as the average and as the desired. Hoedemaekers and ten
Have argue that in everyday usage, 'the normal represents usualness: that
which is familiar, habitual, common, found frequently, or in accordance with
what can be expected' (1999: 539). The abnormal represents that which is
considered different from what is usual. Also in the everyday context, the
normal may become normative, particularly with reference to behaviour.
On the other hand, a typical pattern seems to be that normality, and risks
of abnormality, is understood in a more binary way. It seems to be diffi cult to
think of oneself in terms of a certain relative risk of abnormality. De Swaan
(1990) argues that in cases of 'a small chance of a great misfortune' the odds
will be known to some extent, but this 'does not establish the meaning of the
early danger signals for the proto-patient and the doctor' (1990: 61). For
the patient, results will always have to be translated into an all or nothing:
as an individual, I am either sick or healthy (ibid). Patients do not typically
conceptualize risk in terms of statistical probabilities, but rather as danger.
In the process of making sense of this danger, they draw on ontological
and cosmological assumptions and experiences in their life worlds (Lupton
1995).
This would indicate that
variations
in normality and deviance are (more)
diffi cult to understand within a life-world perspective. Furthermore,
people rather tend to see diagnostic tests and screening as a means to
confi rm
normality, which has been demonstrated for instance in the fi eld
of reproductive health (Green 1990). Also when information about risk
of abnormality is communicated in clinical encounters, the typical pattern
of communication is to confi rm normality and to use different rhetorical
strategies, by practitioners as well as patients, to avoid or down-play the
issue of abnormality (Bredmar and Linell 1999).
Information about risk of abnormality is often presented as abstract
fi gures, scores or graphs, that have to be
re-interpreted
by the individual
to make sense in the context of her own life world (Lupton 1995). A
calculated risk for a specifi c abnormality, a risk fi gure or a curve on a chart,
has to be understood
as something
(familiar to the individual) to make sense
(Adelswärd and Sachs 1996, Olin Lauritzen and Sachs 2001). Furthermore,
everyday reasoning is also characterized by the way people draw on different
explanations and ways of understanding the meaning of risk information,
and are able to move in a fl exible way between different interpretations, also
contradictory ones (Davison
et al
. 1991).
Medical technologies can have intended as well as unintended social
consequences. When people are faced with medical technology, and maybe
particularly when new and yet unfamiliar technology is introduced, this
