Lambert B L
Department of Pharmacy Administration, University of Illinois at Chicago, USA.
Soc Sci Med. 1995 Feb;40(4):545-55. doi: 10.1016/0277-9536(94)e0096-b.
The profession of pharmacy is in the midst of an attempted role expansion. Advocates of a philosophy of practice known as pharmaceutical care want to expand the traditional role of the pharmacist to include patient counseling, drug use monitoring, clinical consultation with physicians, and responsibility for patient outcomes. Other health professions are resisting this role expansion, and it has proven difficult to socialize students into a professional role that is not yet widely accepted. To better prepare students for the workplace, pharmacy educators need a way of assessing the extent to which students have accepted and begun to enact the expanded clinical role. Since role and identity disputes are negotiated in routine interactions between pharmacists and other health professionals, an assessment tool was devised to mimic a common interprofessional interaction. Written messages to physicians were gathered from pharmacy students in response to a hypothetical drug allergy scenario. Pharmacist-physician communication is especially problematic because many of the acts pharmacists routinely perform (e.g. correcting, reminding, reporting, etc.) are intrinsically threatening to a physician's professional identity and sense of self worth. Brown and Levinson's politeness theory explains how situational factors influence peoples' choices in dealing with such identity threatening acts. As an act becomes more threatening, the degree of politeness accompanying the act also increases. Detailed content analysis of pharmacy students' messages to physicians determined that allergy reports were more likely to be made directly than alternative drug recommendations. Recommendations were more likely than reports to be omitted entirely. Implications for pharmacy students' emerging professional identities are discussed.
药学专业正处于角色扩展的尝试之中。一种被称为药学服务的实践理念的倡导者希望扩大药剂师的传统角色，使其包括患者咨询、用药监测、与医生的临床会诊以及对患者治疗结果负责。其他健康专业正在抵制这种角色扩展，而且事实证明，要让学生适应一个尚未被广泛接受的专业角色是很困难的。为了让学生更好地为职场做好准备，药学教育工作者需要一种方法来评估学生接受并开始践行扩展后的临床角色的程度。由于角色和身份争议是在药剂师与其他健康专业人员的日常互动中协商解决的，因此设计了一种评估工具来模拟常见的跨专业互动。针对一个假设的药物过敏场景，收集了药学专业学生给医生的书面信息。药剂师与医生之间的沟通尤其成问题，因为药剂师日常执行的许多行为（例如纠正、提醒、报告等）本质上会威胁到医生的职业身份和自我价值感。布朗和列文森的礼貌理论解释了情境因素如何影响人们在处理此类身份威胁行为时的选择。随着一种行为变得更具威胁性，伴随该行为的礼貌程度也会增加。对药学专业学生给医生的信息进行的详细内容分析表明，过敏报告比替代药物建议更有可能直接给出。建议比报告更有可能被完全省略。文中讨论了这对药学专业学生新兴职业身份的影响。
