Academic journal article Health Sociology Review

In Praise of the Prescription: The Symbolic and Boundary Object Value of the Traditional Prescription in the Electronic Age

Academic journal article Health Sociology Review

In Praise of the Prescription: The Symbolic and Boundary Object Value of the Traditional Prescription in the Electronic Age

Article excerpt

INTRODUCTION

The prescription is a well-known physical object that will be familiar to anyone who has had a medical consultation. Considerable attention has been given to the activities and objects associated with the prescription, particularly at its beginning and end in terms of the rationality and appropriateness of the prescribing act and of the medicines that result from prescribing. This scrutiny has come from disciplines as varied as medicine, anthropology, sociology and history but in contrast very little attention has been given to the actual prescription itself. The aim in this paper is to address this omission and suggest that the physical prescription has significance and value, and does so in different ways for a range of actors. It will be argued that it is more than a mere 'token' for the subsequent medicine and can be understood as a boundary object, permitting communication across this range of actors - including patients, doctors, pharmacists and government - which facilitate a range of successful activities. These include not just the supply of the medicine, which cannot be ignored, but also issues of power ascribed to the prescriber, the financial remuneration of pharmacists, a mechanism of autonomy for the patient, and a surveillance role for government and to some extent pharmacists. Drawing on the use of the standard National Health Service (NHS) prescription in the UK in particular, these claims will be given additional resonance in the context of the planned change to the electronic transfer of prescriptions (NHS Connecting for Health, 2011). Such changes reflect those occurring in many other countries wherein physical prescriptions will be replaced with an electronic transmission process, with details of prescribing intentions being sent from a doctor's computer directly to a pharmacy computer without direct patient involvement. This change will be argued to lead to a number of concerns as to whether the existing value and benefits of the physical prescription will be lost.

The paper is organised in terms of providing a brief review of the prescription from a historical and regulatory perspective, before then describing the literature that has explored the symbolic value of the prescription. It will be shown that several benefits have been identifi ed but that there is firstly a tendency to consider the prescription instrumentally at times, as merely the 'token' for obtaining the ultimately important medicine; and secondly, that these accounts ignore the wider range of actors for whom the prescription has significance. The paper then goes on to suggest the physical prescription may be considered as an example of a successful boundary object that allows communication amongst multiple actors, and a range of examples are provided. The paper then moves on to reflect on the changes to the electronic transfer of prescriptions proposed in the UK and already occurring or being planned in many other countries. It will be argued that this change may threaten several of the aforementioned functions and values of the physical prescriptions. Questions are argued to arise in terms of whether the electronic prescription can function as a boundary object. The paper now goes on to briefly review the history and development of the physical prescription.

THE PRESCRIPTION

The physical prescription is a common, socially recognised object which can be dated back over many centuries. Prescriptions were either records of how a medicine should be prepared and used (rather like a recipe), or instructions on the treatment required for a specific individual qua patient. It is in this latter context that the prescription has relevance to this paper, and would invariably have been produced in a paper format, suitable for writing on. The need for such prescriptions arose primarily because of the traditional separation of the diagnosis and prescribing process from that of compounding and dispensing medicines - the doctor and pharmacist roles respectively. …

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