Experiences of medical dominance in pharmacist-doctor interactions - An elephant in the room?

Abstract

The development of new roles by pharmacists supports the delivery of healthcare services but potentially also encroaches into other healthcare professions' domains of practice. Some novel pharmacy services are only reluctantly accepted by the medical profession and are surrounded by a discourse which expresses medical dominance, with pharmacists facing resistance to their closer involvement in patient care. To investigate whether and how pharmacists may experience medical dominance in their practice. For this qualitative study, pharmacists working in primary care settings were introduced to concepts of sociology in healthcare and medical dominance, then asked to reflect on personal experiences of potential medical dominance, and their emotional and behavioural response. The reflective texts were thematically analysed using a framework based on theories of medical dominance, self-regulation and the influence of emotions on cognition to interpret themes. Twenty-five pharmacists provided detailed reflective accounts. Most worked in a community pharmacy when they experienced medical dominance in interactions with doctors. They described how doctors demarcated territory, evaded scrutiny or disparaged pharmacists' professional expertise. Pharmacists perceived limited options in negotiating these experiences and often employed patients in resolving issues which were left unaddressed. They felt frustrated, undervalued and angry after their experiences and described apprehensiveness in future interactions with doctors. Although experiences of medical dominance by pharmacists working in primary care seem to be an infrequent though regular occurrence pharmacists do not seem to be well prepared to counter or negotiate around it. Perceived and actual dominance in interprofessional interactions with doctors are stressors which may affect pharmacists' ability to problem-solve, their role effectiveness and satisfaction.