The rise of non-medical prescribing and medical dominance

Abstract

This article contributes to the continuing debate on the professional dominance of medicine given the rising number of professions allied to medicine that now have the legal authority to prescribe and could potentially threaten this dominance. The key questions addressed are whether non-medical prescribers represent a threat to the dominance of medicine and if they do not, what has mediated doctors' response to these newer prescribers such that they are able to retain dominance? Drawing on Abbott's work on jurisdictional claims, this paper explores how the rise of non-medical prescribing has led to competing jurisdictional claims over prescribing between doctors and non-medical prescribers. This paper particularly focuses on pharmacist prescribing and how competing jurisdictional claims could be settled. It discusses why the profession of medicine is still dominant and the importance of professional ideologies to influencing the outcome of competing jurisdictional claims. The professional ideology of medicine has shifted from valuing prescribing to valuing the indeterminacy involved in complex clinical decision making, illustrating medicine's ability to adapt, retain dominance and maintain cultural authority over clinical knowledge. In contrast, pharmacist prescribers' professional ideology involves having specialist medicines expertise and being safe prescribers. Pharmacists draw upon this ideology to argue their unique competence as a prescriber: given their pharmacological knowledge and attention to detail which facilitates their role as clinical checker or 'safety net' on prescribing. However, medicine's cultural authority in clinical decision-making enables, when there are competing jurisdictional claims over prescribing, for doctors to retain intellectual jurisdiction: control over the cognitive knowledge base involved in prescribing and clinical decision making. Could this be eroded to a weaker form of control involving advisory jurisdiction? Should political developments further favour the widespread acceptance of prescribing as a core part of the pharmacist's role, an erosion to advisory jurisdiction may yet be possible.

Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review

“…Despite its many benefits, the UK adoption rates for IP vary,55 56 with medical opposition to prescribing roles,57 58 training course drop-out,46 delayed prescribing onset59 60 and role underuse reported 61–64. Difficulties with implementation are frequently cited 43 46 59 65–67.…”

Orden De Género: Un Reto Histórico Y Actual Para La Enfermería

“…Al respecto, es apreciable que las médicas dieron continuidad al denominado "juego de médico-enfermera", tradicionalmente limitado a los hombres que ejercían la medicina y las mujeres que se desempeñaban como enfermeras, donde, aunque evitaban la confrontación de sus visiones y ejercicio profesional, tampoco existía una relación colaborativa ni horizontal. Por el contrario, para los médicos el gremio de enfermería representaría la necesidad de plantearse ceder mayor libertad en la práctica clínica y adoptar un enfoque multidisciplinario en la toma de decisiones sobre el paciente, situaciones típicamente centralizadas en torno a su figura 12 .…”

Social Prescribing Nomenclature, Occupational Therapy and the Theory of Institutional Work: Creating, Maintaining and Disrupting Medical Dominance

“…For instance, one of the key actions to advocate and share best practice in the UK was the appointment of a General Practitioner (GP) as a national clinical champion for social prescribing, arguably representing allegiance to the traditional roles and responsibilities of prescribers and thus creating a firm footing for the social prescribing agenda inside a traditional medical model. Whilst this can be beneficial -particularly for the advocacy of social prescribing -it does means that medicine will likely retain its dominance as it has with the distribution of other forms of prescribing (Weiss, 2020).…”