Biomedical Engineering Reference
In-Depth Information
ANETTE:
But do you have criteria for how you will sort, when you think that
it is a CIN II, or CIN III or CIN I?
ALICE:
Yes, you have that in-built, but it's fl uid you know and specifi cally
when it concerns mild cell changes. On certain days you can be, can be
high on the scale [in your diagnosis]. You can refer those that you may
be a little doubtful about but then the next day you think: '
That
is really
nothing', you don't need to refer that one. You understand, you have
different days, and then it depends on how, if you have sat through a
demonstration with some doctor who diagnoses a little higher than you
are used to. If you have sat through a demonstration with X [name of
physician] who diagnoses very low, or, yes, it depends a lot sort of. You
calibrate yourself all the time with (…) depending on who you have
been at a demonstration with too.
Thus, the borders between cellular classifi cations were not seen as
completely stable, and the border between minor cellular changes and
benign cytology was generally described as a particularly 'fl oating border'.
First, note that the cytodiagnostician above talks about her colleagues in
terms of 'aiming high' (that is, a tendency of going for higher grades), or
'aiming low' (that is, a tendency of going for lower grades). Second, she
'calibrates' her own assessments against those of her colleagues. 'Calibration'
was a strategy that my informants used to 'stabilise' themselves in regard
to the relatively fl uid border between classifi catory categories on the level
of cells, and to keep these borders in congruence with common criteria
and standards. Examples of calibrating strategies were getting a full night
sleep, asking colleagues who could 'counter-balance' their assessment, or, at
Cyto lab, by participating in the demm. Some said that when they wanted
to discuss their assessments they went to a colleague who was
not
at the
same level as themselves. Thus, what at fi rst sight deceptively appeared to be
highly isolated work at the microscopes was in fact often highly interactive:
as described by Anna at Cyto lab:
… so you have your own friends who you go to. The ones you know of.
You don't go to someone that you yourself think, it sounds a little harsh
this, but you don't go to someone, that you think is worse than yourself.
You go to someone who has more experience. You learn quite quickly,
how, on a scale of one to fi ve, how, where the person in question, and
where you yourself lie. So I know that it doesn't help me to go to some
people, I am just as uncertain anyway.
Furthermore, the diagnosticians seemed to keep track of, and compensate
for, infl uences that might have a negative impact on their assessments. Some
said that the shape they were in that day infl uenced what they perceived to
be diffi cult or not, which they claimed was not unique for their group of
professionals. Still others talked about their individual 'best time of day'
