Description of Work:
Fetal Sonographer’s Communication During the Fetal Ultrasound Exam
In addressing the question “What scholars, bodies of work, sources, or approaches should we use to examine the visual aspects of health and medical communication?,” I will present some of the results of my observations of fetal sonogram exams in the United States.
As we know, the visual means of communication used with patients in medical settings is growing in importance. More and more, patients are not only x-rayed; they are scanned and imaged in a variety of ways. The resulting artifacts hold a great deal of medical information for medical professionals and, in almost all cases; it is the physician who first sees them. Some of the resulting artifacts are, of course, later shown to patients in the doctor’s office or hospital room after the doctor has made a diagnosis. However, one area in which visualized medical information is shown directly at the exam to the patient is the fetal ultrasound exam. Because sonographers typically show the fetal ultrasound to the patient, we, as researchers, have a great opportunity to learn how medical sonographers communicate in such situations. For example, we can how workplace medical terminology is translated into the kind of medical rhetoric that expectant mothers and their families can understand.
In order to find this information, I conducted an IRB-approved study over a two-month period in which observed fetal ultrasound exams as they occurred in real time. In these sessions, which took place in a doctor’s office over a two-month period, I was able to observed fetal ultrasound and see and hear what sonographers said to the patients and, often, family members. My goal in conducting this research was not only to update the previous work conducted by Lisa Mitchell, Janelle S. Taylor and a few other medical researchers, but also to approach my observations from a rhetorical and technical communication and point of view. Both Mitchell and Taylor, who had observed fetal ultrasounds and wrote about their experiences, were anthropologists and this background, naturally, impacted their methods and interpretation. I believed that I, as a technical communication scholar, could focus on the rhetorical translation of the sonographer to the expectant mother and often spouses, friends and family members. Through my research, I wanted to know, for example, what kind of words and phrases were used to “translate” medical terminology during the fetal sonogram exam into words that non-medical professionals would understand.
Thus, for two months, I observed 40 sonogram exams in an effort to understand the kind of oral medical communication used in ultrasound communication with nonprofessionals through a rhetorical lens. What I found was a dramatic difference between the kind of information provided to the doctor and the kind of information provided to the expectant mother and her family. In addition, since I had also conducted earlier research in which I interviewed sonographers over the phone about their communication practices during the exam, I was able to analyze both the viewpoint of the medical professional and the viewpoint of the patient situation. For example, I studied sonographers’ word choices, inflection, selection of which parts of the image to discuss and other aspects of what patients saw on the sonogram screen.
What I discovered in my observations was a very different approach used by sonographers in the communication of the exam to the patient as opposed to the doctor. For example, in the early part of pregnancy, it is very difficult for a layperson to interpret the gray, black and white shadows on the screen. As a result, the sonographer must choose to translate this very technical image into words that a layperson can understand. My most important finding was those sonographers’ goals were almost always attempts to help the parent(s) bond with the growing fetus. For example, technical measurements, fetal movement and other medical aspects that were viewed on the sonogram screen were translated into words and phrases that personified the fetus and were used to create bonding between the mother and their expectant child. This verbal communication, combined with features such as the use of pointer arrows on the screen, resulted in a showing of technical medical results that sounded nothing like that used in a typical medical exam.
For example, in comparison to the technical information that the sonographer showed to the physician, the technical information to the patient was translated into words specifically meant to insure that the mother bonded with the growing fetus. This goal of using the sonogram exam to help mothers bond with the fetus resulted in language that was decidedly not medical terminology. For example phrases like “Look! It’s (or “he” or “she”) waving at you” was used a number of times in an obvious effort to promote bonding. Such a pronouncement generated smiles and positive comments from patients.
In addition, a number of other actions and words from the sonographer were used to create bonding with the growing fetus. What is most interesting to me, and what I think it would be to most interesting to conference participants, is how the expectant mother (and families) reacted to the sonographer’s clear attempts to promote bonding. Indeed, the difference in language from the sonographer’s medical report to the doctor as opposed to the oral communication of what was on the sonogram screen to the patients was remarkable.
My results both codified earlier research by Lisa Mitchell and Janelle S. Wilson, who also studied communication in the prenatal exam, but also, revealed how today’s obstetric sonography communication has evolved into “bonding-centered” oral communication, in part greatly due to demands from patient demand who want to know more about the fetus. As I present the results of my information, I will cite the work of medical scholars such as Judy Segal, Ellen Barton, Lisa Mitchell, Janelle S. Wilson, Charlotte H. Korlokke, Raymond Kyle Jones and Rosalind Pollack Petchesky, among others.