Cover not available
Part of
Identity Struggles: Evidence from workplaces around the world
Edited by Dorien Van De Mieroop and Stephanie Schnurr
[Discourse Approaches to Politics, Society and Culture 69] 2017
► pp. 281–298

Chapter 15
‘Even if there were procedures, we will be acting at our own discretion…’

General practitioners’ struggle about identity

The objective of this chapter is to explore how Polish general practitioners (GPs) discursively negotiate their professional identities in relation to their emotions and to the barriers they face in the healthcare system, while dealing with patients presenting Medically Unexplained Symptoms (MUS). The data come from four focus group interviews with 14 Polish GPs and were gathered as part of an international project (Czachowski et al. 2012). This study focuses on the doctors’ identity struggle to combine often competing sets of expectations. Specifically, it shows how the GPs look for ways of balancing the patients’ expectations with emotions, on the one hand, and the professional ethos attached to their roles, impeded by institutional barriers, on the other. It explores discursive strategies of distancing-mitigation, legitimisation and idealisation, drawn upon by the GPs to cope with these identity struggles.
Keywords: Polish general practitioners, identity struggle, Medically Unexplained Symptoms, discursive strategies
Article outline
  • Introduction
  • Background to Polish family medicine and management of patients with MUS
  • Method and research design
  • Analysis
    • Struggling with emotions: containing negative emotions and uncertainty
    • Balancing patients’ expectations with the professional ethos, impeded by institutional barriers
      • Financial and emotional cost incurred by the GP
      • Acting in a non-standard way while treating MUS patients
      • A Polish GP as a one man band
  • Conclusions
  • References
Published online: 26 April 2017
DOI logo
https://doi.org/10.1075/dapsac.69.15sow
References (28)
References
Apker, Julie, and Susan Eggly. 2004. “Communicating professional identity in medical socialization: Considering the ideological discourse of morning report.” Qualitative Health Research 14: 411–429. DOI logoGoogle Scholar
Augoustinos, Martha, Walker, Iain, and Ngaire Donaghue. 2014. Social Cognition: An Integrated Introduction. Third edition. London: Sage.Google Scholar
Beaulieu, Marie-Dominique, Rioux, Marc, Rocher Guy, Samson, Louise, and Laurier Boucher. 2008. “Family practice: professional identity in transition. A case study of family medicine in Canada.” Social Science and Medicine 67 (7): 1153–63. DOI logo.Google Scholar
Czachowski, Sławomir, and Teresa Pawlikowska. 2011. “These reforms killed me’: doctors’ perceptions of family medicine during the transition from communism to capitalism.” Family Practice 28 (4): 437–443. DOI logoGoogle Scholar
Czachowski, Sławomir, Piszczek, Elwira, Sowińska, Agnieszka, olde Hartman, Tim C. 2012. “Challenges in the management of patients with medically unexplained symptoms in Poland: a qualitative study.” Family Practice 29 (2), 228–234. DOI logoGoogle Scholar
Frankel, Richard M. 1995. “Emotion and the physician-patient relationship.” Motivation and Emotion 19: 163–73. DOI logoGoogle Scholar
Health and health care in 2011. [URL].
Heritage, John, and Douglas W. Maynard (eds). 2006. Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Heritage, John, and Steven Clayman. 2010. Talk in Action: Interactions, Identities, and Institutions. Boston: Wiley-Blackwell. DOI logoGoogle Scholar
Hydén, Lars-Christer, and Pia H. Bülow. 2006. “Medical discourse, illness narratives”. In Encyclopaedia of Language and Linguistics, Vol.7, ed. by Keith Brown, 697–703. Oxford: Elsevier. DOI logoGoogle Scholar
Kenny, David A., Veldhuijzen, Wemke, Weijden, Trudy van der, LeBlanc, Annie, Lockyer, Jocelyn, Légaré, France, and Craig Campbell. 2010. “Interpersonal perception in the context of doctor-patient relationships: a dyadic analysis of doctor-patient communication”. Social Science & Medicine 70: 763–768. DOI logoGoogle Scholar
Koller, Veronika. 2008. Lesbian Discourses: Images of a Community. New York and London: Routledge.Google Scholar
. 2012. “How to analyse collective identity in discourse – textual and contextual parameters.” CADAAD Journal 5 (2): 19–38.Google Scholar
Krebs, Erin E., Garrett, Joanne M., and Thomas R. Konrad. 2006. “The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data.” BMC Health Services Research 6: 128.Google Scholar
Mathers, Nigel, Jones, Nicola, and David Hannay. 1995. “Heartsink patients: a study of their general practitioners.” British Journal of General Practice 45: 293–296.Google Scholar
Maynard, Douglas W., and Richard M. Frankel. 2006. “On diagnostic rationality: bad news, good news, and the symptom residua.” In Communication in Medical Care: Interaction between Primary Care Physicians and Patients, ed. by John Heritage and Douglas W. Maynard, 248–278. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Menz, Florian, and Johanna Lalouschek. 2006. “‘I just can’t tell you how much it hurts.’ Gender-relevant differences in the description of chest pain.” In Advances in Medical Discourse Analysis: Oral and Written Contexts. Maurizio Gotti and Françoise Salager-Meyer, 133–154. Bern: Peter Lang.Google Scholar
Moscovici, Serge. 2000. Social Representations: Explorations in Social Psychology. Cambridge: Polity Press.Google Scholar
. 1984. “The phenomenon of social representations.” In Social Representations, ed. by Robert M. Farr and Serge Moscovici, 3–69. Cambridge: Cambridge University Press.Google Scholar
Munday, Jennie. 2006. “Identity in focus: The use of focus groups to study the construction of collective identity.” Sociology 40 (1): 89–105. DOI logoGoogle Scholar
O’Dowd, Tom C. 1988. “Five years of heartsink patients in general practice.” BMJ 297 (6647): 528–530. DOI logoGoogle Scholar
Olde-Hartman, Tim C., Blankenstein, Annette H., Molenaar, Bart, Bentz van den Berg, David, Van der Horst, Henriëtte E., Arnold, Ingrid A., Burgers, Jako, Wiersma, Tjerk, Woutersen-Koch, Hèlen. 2013. “The NHG guideline medically unexplained symptoms (MUS).” Huisarts Wet 2013, 56 (5): 222–30. Retrieved from [URL]/
Pomerantz, Anita. 1986. “Extreme case formulations: a way of legitimizing claims. Human Studies 9(2/3), 219–229. DOI logoGoogle Scholar
Salmon, Peter, Ring, Adele, Dowrick, Christopher F., and Gerry M. Humphris. 2005. “What do general practice patients want when they present medically unexplained symptoms and why do their doctors feel pressurized?” Journal of Psychosomatic Research 59: 255–262. DOI logoGoogle Scholar
Semino, Elena. 2010. “Descriptions of pain, metaphor and embodied simulation.” Metaphor and Symbol 25 (4): 205–226. DOI logoGoogle Scholar
Sowińska, Agnieszka. 2014. “‘I must do everything to eliminate my negative attitude’: Polish general practitioners’ emotions toward patients with medically unexplained symptoms.” In Linguistic approaches to Emotions in Context, ed. by Fabienne Baider and Georgeta Cislaru, 309–330. Amsterdam: Benjamins. DOI logoGoogle Scholar
Steinmetz, Dov, and Hava Tabenkin. 2001. “The ‘difficult patient’ as perceived by family physicians.” Family Practice 18 (5): 495–500. DOI logoGoogle Scholar
Wodak, Ruth. 1996. “‘What pills are you on now?’ Doctors ask, and patients answer.” In Disorders of Discourse, ed. by Ruth Wodak, 35–62. London: Longman.Google Scholar