Ethnography and Repeat Prescribing

Science is something marvellous. But not only the exploding, whizzing, noisy exciting stuff a la ‘I get paid for pointing at things’ Brian Cox type of stuff, but the other stuff, where people do nothing else but talking to people and take notes. That sort of thing.

Until a few years ago I had never heard of the term ‘Ethnography’. I came across the word in a literature search for a project I was working for and promptly had to look it up. Wikipedia tells me that it’s

“qualitative research method aimed to learn and understand cultural phenomena which reflect the knowledge and system of meanings guiding the life of a cultural group”

Ok. That does make sense. But then I saw this: “Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study”. This was a publication by Swinglehurst et al* in one of last years BMJ that obviously attempted to tackle the tricky subject of repeat prescriptions. This is a difficult subject for every GP practice, as producing repeat scripts most of the time means to hand over the production of a large volume of doctors scripts to a computerised clinical management system and members of staff who are often not clinical trained, but have the whole repeat script thing down to a tee. But how do different practices handle their repeat scripts, what kind of variations exist and what makes them safe or unsafe.

The sheer volume of data Swinglehurst and her team produced is impressive: visiting four surgeries with 41000 patients and recording conversations and processes produced 800 pages of field notes. I am sure that took them a bit to code. Their observations about the different routines across the 4 surgeries was highly enlightening and very valuable for our own practices. I quite like their conclusion:

This research suggests that studying technology-supported work routines that appear mundane, standardised, and automated, but which in reality are socially complex requiring a high degree of local tailoring and judgment from frontline staff, opens up a relatively unexplored agenda for research in patient safety.

Quite concise and to the point. There’s obviously more to study on this subject out there, and it is unlikely to involve Super Nova’s, flesh eating plants, Brian Cox, Richard Attenborough, explosions or loud noises. But that doesn’t mean that it isn’t just as relevant.

Science is like that.

* Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study. Deborah Swinglehurst, Trisha Greenhalgh, Jill Russell, Michelle Myall. BMJ 2011;343:d6788

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