Challenges to medicine: the case of prescribing

Abstract This paper examines recent developments in primary care prescribing as potential challenges to the dominance of medicine. These developments, as possible forces for the deprofes-sionalisation and proletarianisation of medicine, were examined using unstructured interviews with five Family Health Service Authority (FHSA) medical advisors and 23 general practitioners (GPs). Three themes emerged from the data. First, GPs did not find the role of the FHSA advisor to be either constraining or inappropriate in relation to prescribing. Secondly, GPs recognised prescribing as a crucial discretionary power in which the prescription was used ‘irrationally’ to cope with a variety of patient, practice or workload pressures. Thus, the only serious managerial threat came from the possibility that such ‘irrational’ prescribing could be curtailed. Finally, GPs felt most concerned by the growing demands and expectations of patients, exacerbated by government policies endorsing greater consumerism. The greatest perceived challenge to clinical autonomy comes, not from proletarianisation in the sense of greater managerial control over medicine's work, but from deprofessionalisation through lay challenges to general practitioners' professional medical expertise.