From enforcement to advocacy - Developing a Foucauldian perspective of pharmacists' reflections on interactions with complex patients.

BACKGROUND: Pharmacists are extending their engagement in health care beyond the supply and monitoring of medicines. Extended roles for pharmacists propose participation in health promotion, disease monitoring and other health surveillance activities, involving them more closely in the lives of patients.

OBJECTIVES: To explore pharmacists' written reflections on patient-centred practice after interactions with people who experience complexity and difficulties to participate in their health care, using a Foucauldian approach.

METHODS: For this qualitative study, pharmacists enrolled in a postgraduate program first watched a video introducing them to the concept of complexity and conflicting patient priorities in health care. They then interacted with patients and reflected on these encounters, their understanding and practice of patient-centeredness. The reflective texts were thematically analysed, using the constant comparison method. Foucault's method of problematisation was used to construct and interpret themes.

RESULTS: Sixty-six pharmacists provided reflective accounts of their patient interaction. Main themes showed how pharmacists emphasised adherence to prescribed medicines, disease monitoring and other desirable health behaviours over tailoring advice to patients' priorities. The Foucauldian analysis elucidated how they prioritised supporting individual patient responsibility over addressing complexity in medication regimens and prescribed health care, risking normalisation of an enforcing role. Pharmacists acknowledged a discrepancy in their patient-centred practice when taking responsibility for patients' medication taking behaviour while encouraging the adoption of certain disciplines to achieve compliance. When pharmacists respected patients' agency and tailored advice and professional support to the needs, wishes and capacities of patients, they developed opportunities for advocacy via increased patient-centeredness.

CONCLUSION: Pharmacists' discursive practices as described in their reflections raise questions of how they employ their sociological and professional roles in negotiating the relatively best outcomes for patients. Pharmacists increasing their awareness of how they conduct themselves may enhance their patient-centeredness when extending participation in disease monitoring and surveillance.