Department of Health Sciences, University of York, York, UK.
Department of Anthropology, University of Durham, Durham, UK.
Sociol Health Illn. 2021 Feb;43(2):336-352. doi: 10.1111/1467-9566.13221. Epub 2020 Nov 22.
Community pharmacy faces ongoing challenges to its economic and social standing. A concern to legitimate professional status explains the attraction of public health. Interventions currently advocated by UK State-sponsored health care seek to reconcile the autonomous 'entrepreneurial' patient with market-driven solutions. Engaging critically with recent Foucauldian sociological work on pharmacy as a conduit for disciplinary power, we explore how professional ambiguity is exploited to 'manage' the subjectivities of community pharmacists. Locating our discussion in the observed empirical realities of pharmacy practice (the inclusion of alcohol and other 'healthy living' advice in the Medicines Use Review), we connect unresolved historical debates in community pharmacy with current ongoing (neoliberal) changes in policy and pharmacy business practices, drawing attention to the poor evidence base underpinning healthy living activities in community pharmacy. Our findings show how community pharmacists struggle to provide meaningful advice, valued by patients. Instead of enhancing professional status, 'add-on' public health roles created the risk of offering little more than an essentialised enactment of consumerist health care. Understanding how patients conceptualise drinking and 'healthy living' in relation to their long-term health, using more open discussions, including the negotiation (rather than provision) of information, could help community pharmacists challenge the current professional vulnerabilities they face.
社区药房面临着经济和社会地位的持续挑战。对合法专业地位的关注解释了公共卫生的吸引力。英国国家资助的医疗保健目前倡导的干预措施试图调和自主的“企业家”患者与市场驱动的解决方案。通过批判性地参与最近关于药房作为纪律权力渠道的福柯社会学工作，我们探讨了如何利用专业上的模糊性来“管理”社区药剂师的主体性。将我们的讨论定位在药房实践中观察到的经验现实中（将酒精和其他“健康生活”建议纳入药物使用审查），我们将社区药房中未解决的历史争论与当前正在进行的（新自由主义）政策和药房商业实践变化联系起来，提请注意社区药房中健康生活活动的基础证据不足。我们的研究结果表明，社区药剂师如何努力提供有意义的建议，这些建议受到患者的重视。“附加”公共卫生角色并没有增强专业地位，反而冒着提供的不过是消费者医疗保健的一种简化表现的风险。通过更开放的讨论，包括对信息的协商（而不是提供），了解患者如何将饮酒和“健康生活”与他们的长期健康联系起来，可以帮助社区药剂师应对他们目前面临的专业脆弱性。
