Prescribers, patients and policy: the limits of technique

Abstract

What is good prescribing? In this paper we will look at the kinds of criteria which are relevant to evaluating prescribing. In particular we wish to challenge, or at least re-frame, the picture of prescribing as an essentially technical process. In so doing we hope to indicate something more general about the power, and limitations, of technical rationality in health care, and to contribute something to work in health care technology assessment. Finally we hope this discussion will act as a stimulus towards a much needed revision of the way 'good' prescribing is defined by current policies, guidelines and protocols.

Antimicrobials used for surgical prophylaxis by equine veterinary practitioners in Australia

“…In contrast, companion animal practitioners who had an antimicrobial use policy in their practice reported using a range of different information sources to guide antimicrobial therapy compared with veterinarians whose practice did not have an antimicrobial use policy . The failure of guidelines to influence prescribing behaviour is multifactorial in human medicine, with a lack of appreciation of an individual's role in addressing the bigger issue , failure to get senior practitioners to support the use of guidelines , perceived inconvenience of appropriate timing of administration of drugs and interference by guidelines in clinical autonomy , all reported to play a role in different scenarios. Some, or all, of these factors may also influence the successful implementation of guidelines in veterinary practices.…”

The appropriateness of psychotropic medicines: an interview study of service users attending a substance misuse service in England

“…The NHS constitution states that NHS services must reflect the needs and preferences of service users [22]. However, there is sometimes conflict between physician-assessed need and what service users want, and how far prescribing should be determined by either of this remains an unresolved question [2, 45]. Service users often have complex needs and risk issues that need to be taken into consideration in treatment decisions.…”

Evaluating Deliberation in Pediatric Primary Care

“…Given the influence of participation in decision-making for many common pediatric concerns, 11,12,15,16 our work informs efforts to target and evaluate interventions to promote participation in the deliberative aspect of decision-making, particularly when such participation could improve outcomes. 10,62 Although previous studies of decision-making focused primarily on information exchange [25][26][27][28][29][30] and neglected the critical component of deliberation, 32,33 these studies noted considerable variability in the decisionmaking process across visits. Substantial variability existed in information exchange during prescribing 25 and in the presence of elements of informed consent during routine clinical decisions.…”

“…[25][26][27][28][29][30] Assessment of the process of expressing and evaluating potential plans (ie, the deliberative process), 24,31 has been neglected, 32 yet consideration of deliberation in addition to information exchange is critical, 32 because without deliberation, deciding on a plan of action becomes entirely a technical task. 33 Furthermore, existing measures are often focused on physician behaviors, 30,[34][35][36][37] are subjective in nature, 36,38,39 or are assessed by patients after the visit and therefore perhaps not reflective of actual events. 25,[40][41][42][43] Subjective measures are also suspected to be biased by dynamics of the physician-patient relationship 43 and by both physician and patient expectations of visit participation.…”