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“Doing prescribing”: high hopes and unexplored beliefs
  1. G Elwyn1,
  2. J Braspenning2
  1. 1Primary Care Research Group, University of Wales Swansea Clinical School, Swansea SA2 8PP, UK
  2. 2Centre for Quality of Care Research, Universities of Nijmegen and Maastricht, 6500 HB Nijmegen, The Netherlands
  1. Correspondence to:
 Professor G Elwyn, Primary Care Research Group, University of Wales Swansea Clinical School, Swansea SA2 8PP, UK; 

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A novel approach to assessing prescribing behaviour involving the views of both patients and doctors, combined with an independent view of “appropriateness”, provides a sophisticated approach to the act of prescribing.

Most consultations between doctors and patients involve transactions that pivot on exchanging a piece of paper on which is inscribed the name of a potion. The prescription is literally an “order” that should be followed by the patient, reified by a pharmaceutical intermediary who enacts the alchemy signified by this most symbolic of documents.

This description uses rather mystical terms perhaps, but it does so in order to point up the often forgotten ritualistic psychotherapeutic elements of this activity. “Doing prescribing” interactions are replete with decisions, many of which involve conflicts, ambivalences and reassurances. Patients will be asking: “is my problem worthy of attention?”; “will it resolve on its own?”; “will the doctor think I’m wasting time?”; “is it worth taking medicine given the opportunity cost, direct cost, possible side effects and interference with ‘natural’ defences?”. On the professional side it is similarly complex: “how confident am I that this …

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