Agnieszka SOWINSKA | Nicolaus Copernicus University (original) (raw)

Papers by Agnieszka SOWINSKA

The objective of this paper is to explore Polish general practitioners’ (GPs) language of emotion... more The objective of this paper is to explore Polish general practitioners’ (GPs) language of emotions used with regard to patients with medically unexplained symptoms (MUS). Specifically, the study focuses on the linguistic expressions and discursive strategies drawn upon in the communication of emotions and value judgments towards this group of patients. This study is part of the larger research project on challenges Polish GPs face while dealing with patients with MUS (cf. Czachowski et al. 2011). The investigation of 4 focus groups revealed, inter alia , that the doctors frequently use labels and metaphors, such as maruda [‘whinger’] or świeta krowa [‘sacred cow’] to refer to and evaluate these patients. Such expressions communicate doctors’ negative emotions. These emotions influenced the doctors’ behaviour during the consultation: the doctors admitted to referring patients with MUS to secondary care or shortening the visit.

Discourse Studies, Mar 8, 2022

The objective of this article is to explore the identity construction by students with invisible ... more The objective of this article is to explore the identity construction by students with invisible disabilities as disclosed in medical consultations at a university health center. In particular, I work on the assumption that analysing the discursive processes through which students with invisible disabilities construct, negotiate and resist their roles and identities may contribute to a better understanding of living and studying with an invisible condition. Taking a discourse analytic approach, I consider identity as a dynamic and negotiable process that takes place in specific interactional occasions. The findings have shown that these students sometimes construct contested identities as patients, students, or experts during medical consultations, responding to conflicting expectations of others and their own.

Discourse Studies, Feb 18, 2018

The aim of this article was to explore identity struggles related to the experience of living wit... more The aim of this article was to explore identity struggles related to the experience of living with medically unexplained symptoms (MUS) in illness narratives of patients with MUS. These patients pose therapeutic and communication challenges as their symptoms do not have an obvious underlying diagnosis. Previous studies have shown that their stories can best be described as ‘chaos narratives’, lacking a chronological development of symptoms or ‘legitimacy narratives’, through which patients seek to legitimize their invisible symptoms. The study draws on 21 interviews with MUS patients. The examples were selected from two contrasting cases in order to show how the patients accomplish their identity struggles through distinctive discursive tools, such as metaphors, modality, personal pronouns, evaluative devices, as well as characteristic interactional structure, navigating around the three identity dilemmas: continuity and change, self and other, and agent or undergoer.

International Journal of Qualitative Studies on Health and Well-being, Jun 10, 2023

Discourse approaches to politics, society and culture, Apr 13, 2017

Pragmatics & beyond, 2014

Gesture

The aim of this paper is to explore speech-accompanying gesture use in presentation of medically ... more The aim of this paper is to explore speech-accompanying gesture use in presentation of medically unexplained symptoms (MUS). The data are 19 video-filmed semi-structured interviews with patients presenting MUS. Four patterns of gestural behaviors are established in symptom presentation: (1) No gesturing; (2) Overall low gesture rate; (3) Overall high gesture rate with low rate for symptoms; (4) Overall high gesture rate with high rate for symptoms. The patients with overall low gesture rate tend to perform deictic gestures, pointing to exact locations of the symptoms; those with overall high gesture rate and low symptom rate produce metaphorics, and those who gesticulate at high rates – mainly iconics and metaphorics. Although exact factors that lead to the four types of gesturing patterns are unclear, the findings encourage medical professionals to attend to the information in gesture use in order to obtain a better understanding of the patient’s experience of MUS.

Communication and Medicine, 2018

The objective of the study is to explore how patients presenting medically unexplained symptoms (... more The objective of the study is to explore how patients presenting medically unexplained symptoms (MUS) - that is, symptoms that do not have an obvious underlying diagnosis - communicate agency. It is assumed that agency can be exercised verbally through narrative structure and content as well as nonverbally through patients' behaviours, in particular their gestures. This, in turn, points to the ways patients conceptualize their identities and selves. Pauses and disfluencies in the patients' accounts as well as an imprecise use of gestures can indicate a cognitive or conceptual conflict and uncertainty related to MUS. This paper reports on preliminary findings obtained from the analysis of 20 video-filmed interviews with Polish patients with MUS, and presents two case studies of patients who, despite fairly similar medical test results, deliver different illness narratives: (1) a narrative indicative of low agency and characterized by fragmentation, vagueness, repetitiveness a...

European Psychiatry, 2017

IntroductionDepression occurs frequently in primary care. Its broad clinical variability makes it... more IntroductionDepression occurs frequently in primary care. Its broad clinical variability makes it difficult to diagnose. This makes it essential that family practitioner (FP) researchers have validated tools to minimize bias in studies of everyday practice. Which tools validated against psychiatric examination, according to the major depression criteria of DSM-IV or 5, can be used for research purposes?MethodAn international FP team conducted a systematic review using the following databases: Pubmed, Cochrane and Embase, from 2000/01/01 to 2015/10/01.ResultsThe three databases search identified 770 abstracts: 546 abstracts were analyzed after duplicates had been removed (224 duplicates); 50 of the validity studies were eligible and 4 studies were included. In 4 studies, the following tools were found: GDS-5, GDS-15, GDS-30, CESD-R, HADS, PSC-51 and HSCL-25. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value were collected. The Youden index was calculated....

Argumentation, 2014

Building on our diverse research traditions in the study of reasoning, language and communication... more Building on our diverse research traditions in the study of reasoning, language and communication, the Polish School of Argumentation integrates various disciplines and institutions across Poland in which scholars are dedicated to understanding the phenomenon of the force of argument. Our primary goal is to craft a methodological programme and establish organisational infrastructure: this is

BMC Research Notes, 2018

Objective: From a systematic literature review (SLR), it became clear that a consensually validat... more Objective: From a systematic literature review (SLR), it became clear that a consensually validated tool was needed by European General Practitioner (GP) researchers in order to allow multi-centred collaborative research, in daily practice, throughout Europe. Which diagnostic tool for depression, validated against psychiatric examination according to the DSM, would GPs select as the best for use in clinical research, taking into account the combination of effectiveness, reliability and ergonomics? A RAND/UCLA, which combines the qualities of the Delphi process and of the nominal group, was used. GP researchers from different European countries were selected. The SLR extracted tools were validated against the DSM. The Youden index was used as an effectiveness criterion and Cronbach's alpha as a reliability criterion. Ergonomics data were extracted from the literature. Ergonomics were tested face-to-face. Results: The SLR extracted 7 tools. Two instruments were considered sufficiently effective and reliable for use: the Hospital Anxiety and Depression Scale and the Hopkins Symptoms Checklist-25 (HSCL-25). After testing face-to-face, HSCL-25 was selected. A multicultural consensus on one diagnostic tool for depression was obtained for the HSCL-25. This tool will provide the opportunity to select homogeneous populations for European collaborative research in daily practice.

BMC Family Practice, 2018

Background: Patients with medically unexplained symptoms (MUS) are common in primary care, and po... more Background: Patients with medically unexplained symptoms (MUS) are common in primary care, and pose a communicative and therapeutic challenge to GPs. Although much has been written about GPs' frustration and difficulties while dealing with these patients, research presenting the patients' perspectives on MUS still seems to be scarce. Existing studies have demonstrated the patients' desire to make sense of symptoms, addressed the necessity for appropriate and acceptable explanation of MUS, and revealed stigmatization of patients with symptoms of mental origin. Treatment in primary care should focus on the patient's most essential needs and concerns. The objective of this paper is to explore Polish patients' perspectives on living with MUS. Methods: A qualitative content analysis of 20 filmed, semi-structured interviews with patients presenting MUS (8 men and 12 women, aged 18 to 57) was conducted. All patients were diagnosed with distinctive somatoform disorders (F45), and presented the symptoms for at least 2 years. The interviews were transcribed verbatim and analysed independently by two researchers. Results: Four major themes emerged: (1) experiences of symptoms; (2) explanations for symptoms; (3) coping; (4) expectations about healthcare. Within the first theme, the patients identified the following sub-themes: persistence of symptoms or variability, and negative emotions. Patients who observed that their symptoms had changed over time were better disposed to accept the existence of a relationship between the symptoms and the mind. The second theme embraced the following sub-themes: (1) personal explanations; (2) social explanations; (3) somatic explanations. The most effective coping strategies the patients mentioned included: the rationalization of the symptoms, self-development and ignoring the symptoms. The majority of our respondents had no expectations from the healthcare system, and stated they did not use medical services; instead, they admitted to visiting psychologists or psychiatrists privately. Conclusion: Patients with MUS have their own experiences of illness. They undertake attempts to interpret their symptoms and learn to live with them. The role of the GP in this process is significant, especially when access to psychological help is restricted. Management of patients with MUS in the Polish healthcare system can be improved, if access to psychologists and psychotherapists is facilitated and increased financial resources are allocated for primary care. Patients with MUS can benefit from a video/filmed consultation with a follow-up analysis with their GP.

Journal of the American Medical Directors Association, 2013

Background: Multimorbidity is a new concept encompassing all the medical conditions of an individ... more Background: Multimorbidity is a new concept encompassing all the medical conditions of an individual patient. The concept links into the European definition of family medicine and its core competencies. However, the definition of multimorbidity and its subsequent operationalization are still unclear. The European General Practice Research Network wanted to produce a comprehensive definition of multimorbidity. Method: Systematic review of literature involving eight European General Practice Research Network national teams. The databases searched were PubMed, Embase, and Cochrane (1990e2010). Only articles containing descriptions of multimorbidity criteria were selected for inclusion. The multinational team undertook a methodic data extraction, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Results: The team identified 416 documents, selected 68 abstracts, included 54 articles, and found 132 definitions with 1631 different criteria. These criteria were aggregated into 11 themes that led to the following definition: Multimorbidity is defined as any combination of chronic disease with at least one other disease (acute or chronic) or biopsychosocial factor (associated or not) or somatic risk factor. Any biopsychosocial factor, any risk factor, the social network, the burden of diseases, the health care consumption, and the patient's coping strategies may function as modifiers (of the effects of multimorbidity). Multimorbidity may modify the health outcomes and lead to an increased disability or a decreased quality of life or frailty. Conclusion: This study has produced a comprehensive definition of multimorbidity. The resulting improvements in the management of multimorbidity, and its usefulness in long term care and in family medicine, will have to be assessed in future studies.

BMC Family Practice, 2019

Background: General Practice (GP) seems to be perceived as less attractive throughout Europe. Mos... more Background: General Practice (GP) seems to be perceived as less attractive throughout Europe. Most of the policies on the subject focused on negative factors. An EGPRN research team from eight participating countries was created in order to clarify the positive factors involved in appeals and retention in GP throughout Europe. The objective was to explore the positive factors supporting the satisfaction of General Practitioners (GPs) in clinical practice throughout Europe. Method: Qualitative study, employing face-to-face interviews and focus groups using a phenomenological approach. The setting was primary care in eight European countries: France,

BMC Family Practice, 2016

Background: Looking at what makes General Practitioners (GPs) happy in their profession, may be i... more Background: Looking at what makes General Practitioners (GPs) happy in their profession, may be important in increasing the GP workforce in the future. The European General Practice Research Network (EGPRN) created a research team (eight national groups) in order to clarify the factors involved in GP job satisfaction throughout Europe. The first step of this study was a literature review to explore how the satisfaction of GPs had been studied before. The research question was "Which factors are related to GP satisfaction in Clinical Practice?" Methods: Systematic literature review according to the PRISMA statement. The databases searched were Pubmed, Embase and Cochrane. All articles were identified, screened and included by two separate research teams, according to inclusion or exclusion criteria. Then, a qualitative appraisal was undertaken. Next, a thematic analysis process was undertaken to capture any issue relevant to the research question. Results: The number of records screened was 458. One hundred four were eligible. Finally, 17 articles were included. The data revealed 13 subthemes, which were grouped into three major themes for GP satisfaction. First there were general profession-related themes, applicable to many professions. A second group of issues related specifically to a GP setting. Finally, a third group was related to professional life and personal issues. Conclusions: A number of factors leading to GP job satisfaction, exist in literature They should be used by policy makers within Europe to increase the GP workforce. The research team needs to undertake qualitative studies to confirm or enhance those results.

BMC Family Practice, 2015

Background: Multimorbidity is an intuitively appealing, yet challenging, concept for Family Medic... more Background: Multimorbidity is an intuitively appealing, yet challenging, concept for Family Medicine (FM). An EGPRN working group has published a comprehensive definition of the concept based on a systematic review of the literature which is closely linked to patient complexity and to the biopsychosocial model. This concept was identified by European Family Physicians (FPs) throughout Europe using 13 qualitative surveys. To further our understanding of the issues around multimorbidity, we needed to do innovative research to clarify this concept. The research question for this survey was: what research agenda could be generated for Family Medicine from the EGPRN concept of Multimorbidity? Methods: Nominal group design with a purposive panel of experts in the field of multimorbidity. The nominal group worked through four phases: ideas generation phase, ideas recording phase, evaluation and analysis phase and a prioritization phase. Results: Fifteen international experts participated. A research agenda was established, featuring 6 topics and 11 themes with their corresponding study designs. The highest priorities were given to the following topics: measuring multimorbidity and the impact of multimorbidity. In addition the experts stressed that the concept should be simplified. This would be best achieved by working in reverse: starting with the outcomes and working back to find the useful variables within the concept. Conclusion: The highest priority for future research on multimorbidity should be given to measuring multimorbidity and to simplifying the EGPRN model, using a pragmatic approach to determine the useful variables within the concept from its outcomes.

GFQ English version. The English version of the Gut Feeling Questionnaire. (DOCX 27 kb)

GFQ French Version. The French version of the Gut Feeling Questionnaire. (DOCX 29 kb)

Journal of Pragmatics, 2019

In this paper we aim to establish the forms and functions of vicarious narratives told by Polish ... more In this paper we aim to establish the forms and functions of vicarious narratives told by Polish doctors in two contexts of talk at work: face to face interaction in focus group discussions and asynchronous interaction in blogs. The widespread use of social media such as blogs, thanks to their technological affordances, has provided researchers with diverse types of narratives, including narratives in medical contexts (Page, 2012; Georgakopoulou, 2013). We draw on a narrative-pragmatic approach to studying workplace discourse (Norrick, 2013). We propose that doctors legitimise their professional identity through vicarious narratives by communicating professional values, expertise and authority. They also build solidarity and share experience with others or mitigate responsibility. Furthermore, in both focus groups and medical blogs, professional authority may merge with self-disclosure. When it comes to differences, narratives about others in focus group discussions are more formulaic, while in blogs they are more informal and may be episodic. Finally, positive emotions and positive evaluation seem to characterise focus group discussions, while negative evaluation of others is present in blogs.

European Journal of General Practice, 2016

European general practitioners recognize the EGPRN enhanced, comprehensive concept of multimorbid... more European general practitioners recognize the EGPRN enhanced, comprehensive concept of multimorbidity. They add the use of Wonca's core competencies and the patient-doctor relationship dynamics for detecting and managing multimorbidity. The EGPRN concept of multimorbidity leads to new perspectives for the management of complexity.