Ambiguity as Resource: Interventional Pain Medicine and the Management of Suffering and Uncertainty in India

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 17. Healthcare Providers & Practice I

Abstract

Healthcare professionals frequently navigate uncertainty as a significant feature of clinical medicine. Conditions associated with chronic pain, which frequently lack clear biological evidence of aetiology and suffering, are characterised by high levels of multi-dimensional uncertainty. Although how clinical uncertainties associated with the management of chronic pain are navigated by pain physicians has not yet been adequately examined. This study uses the case of interventional pain medicine in India to examine how uncertainty manifests and is navigated at the micro-interactional level in clinical contexts. The paper draws on 200 hours of ethnographic fieldwork conducted at a specialised pain clinic in North India, including observations drawn from 109 patient consultations. It argues that pain physicians use communicative ambiguity strategically as an interactional resource while navigating uncertain treatment outcomes. They do so by invoking metaphors of uncertainties associated with other chronic illnesses, uncertainties inherent to their expertise, making no-knowledge claims, and delienating a wide spectrum of expected pain relief following an intervention. It is demonstrated that strategic ambiguity allows pain physicians to execute their expertise and tasks related to their therapeutic role to three ends: managing patient expectations of pain relief, retaining the credibility of their clinical and scientific expertise, and encouraging the uptake of analgesic care among patients.

Author

• Jaya Mathur, Jawaharlal Nehru University