The sociology of prescribing: A narrative review and agenda

Prescribing is a key symbol of the authority of medical practice, and is restricted to qualified clinicians who permit access to many medicines. Variously framed as over- or under-prescribed, or otherwise inadequately provisioned, sociologists have attended to the clinical logics and practices underpinning prescribing. Despite being a key feature in medical practice, there is only scattered attention to a ‘sociology of prescribing’ or a general social theory of prescribing. In contrast, there has been a flourishing sociology of diagnosis in recent decades that organises the field. Revisiting a nascent sociology of prescribing that emerged in the 1970s, this article reviews sociological (and other social scientific) contributions to prescribing and provides an agenda for a contemporary approach to sociological perspectives on drug prescribing. A sociology of prescribing conceptualises the act of prescribing as an embodied and relational social practice shaped through the complex choreographies of health encounters and systems. Early prescribing literature documented variations in prescribing practices across clinical sites, attended to the divergent expectations of the prescription between doctor and patient, and characterised prescribing as symbolically potent, enabling the doctor to alleviate, validate, and placate patient concerns. While health industries understand prescribing as a technical process of following the mandates of ethics and evidence-based medicine (or ‘rational prescribing’), social research has identified pharmaceutical detailing, workplace cultures, and practice-relevant knowledge as key determinants of prescribing practice. Recent sociological inquiry has also focused on professional tensions with the expansion of non-medical prescribing, critiques of the (bio)medicalisation and pharmaceuticalisation of society, and the impacts of new technologies like electronic prescribing. I propose care, expertise, power, and work as domains for future sociological inquiry on prescribing. Attending to these domains will be vital as prescribing is continually reimagined through transformations in the technological and political arrangements of pharmaceuticals and healthcare.