Struggles Over Antibiotics: Physicians’ Stance-Taking Toward a Nonconforming Policy in an Intensive Care Unit

• Published in: Qualitative health research Vol. 27; no. 13; pp. 2006 - 2018
• Main Authors: Caronia, Letizia, Saglietti, Marzia
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2017; SAGE PUBLICATIONS, INC
• Subjects: Anthropology, Cultural; Anti-Bacterial Agents - administration & dosage; Antibiotics; Attitude of Health Personnel; Bacteria; Clinical Decision-Making; Communicable Diseases - diagnosis; Communicable Diseases - drug therapy; Communication; Decision making; Drug resistance; Ethnography; Fieldwork; Health care; Health Policy; Health technology assessment; Humans; Infectious diseases; Intensive care; Intensive Care Units; Interprofessional Relations; Management; Medical decision making; Medical diagnosis; Morality; Off-label; Off-Label Use; Physician's Role; Physicians; Physicians - psychology; Practice Patterns, Physicians; Prescriptions; Qualitative research; Teams; Italy; Stance-taking; “off label” clinical policies; Ethnography; Conversation Analysis; infection; Antibiotics; Doctor-doctor interaction; Antimicrobial Resistance; Antibiotic Prescribing; Italy; Medical decision-making; Intensive Care Uniti (ICU)
• ISSN: 1049-7323; 1552-7557
• DOI: 10.1177/1049732317723316

One of the most pressing contemporary health care challenges consists in rethinking antibiotic use to contrast the increase of multidrug resistant bacteria. Drawing on an ethnographic fieldwork in an Intensive Care Unit that adopts a nonconforming policy of antibiotic stewardship, this article analyzes doctor–doctor interaction concerning infectious disease diagnosis and antibiotic treatment. By analyzing examples of medical decision-making from a corpus of video-recorded morning briefings, we focus on physicians’ stance-taking toward the ward’s nonconforming policy and illustrate how it is contingently situated along a continuum from strong commitment to overt resistance. We suggest that physicians’ oscillating stance-taking is favored by the moral load of following an extreme and “off-label” policy and, in turn, impacts on the way this policy is practically accomplished as a highly reflective interactional achievement by the team members.