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Perceptions of prescribing violations by doctors: A qualitative study using semi-structured interviews
Deborah Kirkham1, Mary P Tully2
1Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
British Journal of Clinical Pharmacology
|July 30, 2026
Summary
Foundation Year 2 (FY2) doctors often normalize deliberate prescribing violations due to workload and system pressures. Addressing these requires improved prescribing systems, clearer responsibilities, and support for junior clinicians challenging unsafe norms.
Area of Science:
- Medical error research
- Clinical practice analysis
- Healthcare systems research
Background:
- Prescribing violations, deliberate deviations from guidelines, are under-researched errors.
- These violations are often normalized in demanding hospital settings.
Purpose of the Study:
- To investigate Foundation Year 2 (FY2) doctors' perceptions of prescribing violations in their daily work.
- To understand the context and influences surrounding these violations.
Main Methods:
- Semi-structured interviews with 12 FY2 doctors across UK hospitals.
- Thematic analysis of interview data using Reason's taxonomy and constant comparison.
- Discussion prompted by realistic prescribing violation scenarios.
Main Results:
- FY2 doctors perceive routine and situational prescribing violations as common and necessary responses to workload and time constraints.
- Factors influencing violations include diffusion of responsibility, hierarchy, drug risk perception, and limited feedback.
- Optimizing violations were not observed; many violations were seen as low-risk due to perceived safety nets.
Conclusions:
- Prescribing violations are viewed by FY2 doctors as an ingrained aspect of clinical practice.
- Recommendations include designing practical prescribing systems, clarifying accountability, enhancing feedback, and supporting junior doctors in challenging norms.
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