School of Pharmacy & Pharmaceutical Sciences, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, United Kingdom.
Res Social Adm Pharm. 2021 Mar;17(3):632-637. doi: 10.1016/j.sapharm.2020.05.015. Epub 2020 May 16.
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.
这篇文章为关于医学专业主导地位的持续争论做出了贡献，鉴于越来越多的医学相关专业现在拥有开具处方的法律权力，并且可能对这种主导地位构成威胁。文中探讨的关键问题是，非医疗从业者是否对医学的主导地位构成威胁，如果不是，医生对这些新的从业者的反应是什么，使他们能够保持主导地位？本文借鉴了 Abbott 关于司法主张的研究，探讨了非医疗处方的兴起如何导致医生和非医疗从业者之间在处方权方面的竞争司法主张。本文特别关注药剂师的处方权，以及如何解决竞争的司法主张。本文讨论了为什么医学专业仍然占据主导地位，以及专业意识形态对竞争司法主张结果的重要性。医学的专业意识形态已经从重视处方转变为重视复杂临床决策中涉及的不确定性，这说明了医学适应、保持主导地位和对临床知识保持文化权威的能力。相比之下，药剂师的处方专业意识形态涉及到具有专业的药物知识和安全的处方能力。药剂师利用这种意识形态来论证他们作为处方者的独特能力：鉴于他们的药理学知识和对细节的关注，有助于他们在处方方面发挥临床检查者或“安全网”的作用。然而，医学在临床决策中的文化权威使得在处方方面存在竞争的司法主张时，医生能够保留知识管辖权：控制与处方和临床决策相关的认知知识库。这可能会削弱为涉及咨询管辖权的较弱形式的控制吗？如果政治发展进一步有利于广泛接受药剂师在处方方面的核心作用，那么对咨询管辖权的侵蚀仍然是可能的。
