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This paper explores the symbolic and boundary object value of the traditional paper prescription in the context of the planned move to the wider use of electronic prescribing in primary care in the UK and many other countries. It is argued that the traditional paper prescription possesses symbolic value and has been occasionally recognised but more often ignored in favour of the ultimate social object that is the medicine. This paper argues that considering the physical prescription as a boundary object within Star and Griesemer's typology as a 'standardised form' recognises its significance for a range of actors, including not just doctors and patients, but also pharmacists and other stakeholders, in areas such as professional authority, the ceremony of the medical consultation, patient autonomy, surveillance, financial income, as well as medicine supply. The paper goes on to reflect on this boundary object interpretation in the context of the current move to the electronic transfer of prescriptions and it is argued that this may threaten the existing boundary object and its associated value. It also raises broader concerns as to what happens when boundary objects are modified or replaced. [ABSTRACT FROM AUTHOR]

Scientific-bureaucratic medicine (SBM) has been the dominant discourse on evidence-based medicine in the English National Health System (NHS). It has being claimed that SBM has led to new forms of medical professionalism with an emphasis on organisational values and the control of autonomy. This paper explores the medical professions' response to SBM, where SBM is manifested in the form of National Institute of Health and Clinical Excellence (NICE) guidelines. Seventy-four face-to-face informal interviews were carried out with clinicians and managers between 2007 and 2009. Three major themes emerged from the analysis each of which was linked to doctors' receptiveness to NICE guidelines implementation. The first emphasised organisational values, which accounted for conditional acceptance of NICE guidelines. The second was proactive professionalism or entrepreneurial professionalism, which was linked to the rejection of NICE guidelines and the emergence of alternative forms of introducing new ideas for the expansion of their clinical practice. The third was related to the prominence of clinical autonomy linked with doctors' resistance to the use of NICE guidelines. It is argued that this evidence does not reflect a significant emergence of new forms of professionalism but the development of multiple occupational identities. [ABSTRACT FROM AUTHOR]