Directiness and deference in pharmacy students' messages to physicians

The profession of pharmacy is in the midst of an attempted role expansion. Advocates of a philosophy of practice known as pharmaceutical care want to expand the traditional role of the pharmacist to include patient counseling, drug use monitoring, clinical consultation with physicians, and responsibility for patient outcomes. Other health professions are resisting this role expansion, and it has proven difficult to socialize students into a professional role that is not yet widely accepted. To better prepare students for the workplace, pharmacy educators need a way of assessing the extent to which students have accepted and begun to enact the expanded clinical role. Since role and identity disputes are negotiated in routine interactions between pharmacists and other health professionals, an assessment tool was devised to mimic a common interprofessional interaction. Written messages to physicians were gathered from pharmacy students in response to a hypothetical drug allergy scenario. Pharmacist-physician communication is especially problematic because many of the acts pharmacists routinely perform (e.g. correcting, reminding, reporting, etc.) are intrinsically threatening to a physician's professional identity and sense of self worth. Brown and Levinson's politeness theory explains how situational factors influence peoples' choices in dealing with such identity threatening acts. As an act becomes more threatening, the degree of politeness accompanying the act also increases. Detailed content analysis of pharmacy students' messages to physicians determined that allergy reports were more likely to be made directly than alternative drug recommendations. Recommendations were more likely than reports to be omitted entirely. Implications for pharmacy students' emerging professional identities are discussed.