Zones of Expertise and the Management of Uncertainty in Genetics Risk Communication

Abstract

In the context of risk communication in genetic counseling, there appears to be a tension between clients seeking an authoritative, definitive risk assessment and the geneticist-expert actively defining the boundaries of his or her (in)expertise through formulation of uncertainty that is such a feature of genetic disorders. In the process of demarcating his or her zone of expertise, he or she defers to the judgment of other medical colleagues with expertise in "adjacent" areas. Our claim is that the genetic counselor delineates his or her (in)expertise through a systematic deployment of a range of modalized discourse strategies (e.g., contrast and hedging) while claiming authority in a limited knowledge field. At the broader professional level, this is motivated in part by the limits to professional knowledge and in part by the desire to maintain a "nondirective" (i.e., neutral) stance. Our analysis focuses on the expert formulation of uncertainty in a single counseling session around 4 strategic moments: (a) display of specialist knowledge, (b) pronouncement of considered judgment, (c) response to clients' volunteered information, and (d) maintenance of a nondirective stance in the face of explicit advice seeking by clients.