Elsevier

Health & Place

Volume 34, July 2015, Pages 251-256
Health & Place

Space, time, and emotion in the community pharmacy

https://doi.org/10.1016/j.healthplace.2015.06.003Get rights and content

Abstract

Community pharmacies have a complex relationship with the field of health care. This is especially so in countries where pharmaceuticals are dispensed from privately owned retail premises. Using qualitative data and social theoretical concepts, we argue that the time, space and emotional entanglements that take place in and through these sites are far from simple and can be more or less productive in terms of meeting customer needs and fostering professional identity for pharmacists. Unpicking this complexity has the potential to highlight lacunae that result from differential expectations.

Introduction

Spaces in community pharmacies are constantly being ‘woven together out of ongoing stories’ (Massey, 2005, p. 131) in spacetime as the various professionals, staff and pharmacy users interact around the pivotal point of the counter which divides the shop activities from the metaphorically and sometimes literally closed off professional space of the dispensary. The counter serves as the place where sales are made and medicines dispensed; it also protects the professional space from the public (Rapport et al., 2009) and acts as the point where customers negotiate with ‘gatekeeper’ staff about waiting times for prescriptions or direct access to speak to the professionals in the dispensary. Scenes of varying complexity evolve from moment to moment with all present seeking to manage the conflicting demands of their needs, responsibilities and roles. All of these acts of managing are negotiated through spacetime and involve overt and covert emotional entanglements. These spatial, temporal, emotional entanglements are currently being stretched with the expansion and extension of pharmacists' roles in New Zealand where this study is located. We are concerned in this paper with what Pile (2010) terms the space in-between and how emotions, space and time bend and flex in the space between people and between people and things to produce therapeutic events – to function as therapeutic landscapes – or not.

Geographers have been instrumental in expanding the investigation of place and settings for health and health care in a wide variety of ways. Space prevents a full review, but see for example Curtis (2004) on health inequality and place, Gesler and Kearns (2005) on culture, place and health – including landscapes of healing, Glover and Parry (2009) on the role of ‘third places’ and Kearns (1993) on the importance of moving beyond the biomedical in understandings of health and place. The literature on therapeutic landscapes, see for example Conradson (2005), Curtis et al. (2007), Gesler (1992), Smyth (2005), Williams (2007), and Wood et al. (2015) is especially important in the context of this research with its explicit argument that the production, maintenance and negotiation of health and wellbeing involves far more than reductionist biomedically-inflected, emotionless and placeless absence-of-disease approaches. Community pharmacy is a largely neglected area in qualitative health geography with a few notable exceptions; see Rapport et al. (2009). These health care spaces are important settings at least partially because they have one of the lowest barriers to entry of any such formal health care setting, requiring no appointments as primary care does, or triage process as is the case in emergency secondary care settings. The community pharmacy is a ‘landscape’ that can at once be seen as one which may facilitate healing in the biomedical sense, but also one through which more holistic practises related to health promotion and the quest for well-being are enacted via the use of complementary medicines. This is not to suggest that wellbeing always relies upon the ingestion of something.

Section snippets

Theorising time, space and emotion in the community pharmacy

Seeking health care is a spatio-temporal activity. Health-related transactions conventionally occur in particular places; the buildings that house health activities assume a significance of their own (Gesler and Kearns, 2005). Community pharmacies are an example of spaces which are, using Crang’s (2005, p. 204) words, ‘created through actions’. They are a prosaic example of the ways that a ‘building produces its site’ (Wigley, 1993 p. 61 cited in (Crang, 2005, p. 204)).1

Method

We began our study by investigating the social and spatial context in which community pharmacy operates, with particular interest in the contrasting perspectives of the pharmacists who work in them and the public who visit them. A qualitative approach was chosen as the most appropriate method to gain in-depth data in this relatively under-researched field. Approval was granted for the study by the [University of Otago] Human Ethics Committee.

A purposive sampling strategy was used to select 20

Time in the community pharmacy

Understanding the tensions that matter in the tangle of things, events and people that make up an encounter in a community pharmacy requires a particular way of looking. Adam’s (1998, p.11) timescape perspective allows for the investigation of ‘temporal features of living’ and we would add working. She calls timescapes ‘the embodiment of practiced approaches to time’ (ibid). This is not to imply that ‘practiced approaches to time’ are static and waiting to be revealed, but simply that they are

Spaces: contesting boundaries, negotiating spaces

The physical space of a community pharmacy witnesses an ever changing assemblage of actions and actors coming together in unpredictable ways for a complex mix of purposes and functions. Members of the public use the pharmacy to have prescriptions filled, to get advice from the pharmacist, and buy over-the-counter medicines or other products on sale, sometimes several of these in the one visit. The staff that work in the pharmacy similarly fill a variety of roles and take on different identities

Emotion

Time and spacescapes were not simply neutrally negotiated. For both pharmacists and members of the public emotion mediated their experiences. The world of work is often conceived of as a space ‘unmarked by emotion’ (McDowell, 1997, p. 34). When emotion is discussed the focus is often on such concepts as emotional labour (Hochschild, 1983). McDowell (1997) argued that the stock exchange trading floor was a site in which usual expectations to control emotions at work were relaxed. The emotions

Concluding comments

At a time when there is external pressure for professional groups to alter their roles, there is a key role for geographers in investigating in depth the ways that the tangle of spacetime events calls forth identities in ways that may serve to fuel or snuff the desire for change. Focusing on the themes of time, space and emotion as we have done in this paper has allowed us to capture some of the ways that in the unfolding of the event – one which involves entering a spacetime negotiation in the

Acknowledgements

This research would not have been possible without funding from the Canterbury Medical Research Foundation and the willing participation of the people we interviewed. We are grateful for both of these.

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