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Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing

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  • Broom, Alex
  • Broom, Jennifer
  • Kirby, Emma

Abstract

The prospect of an ‘antimicrobial perfect storm’ in the coming decades through the emergence and proliferation of multi-resistant organisms has become an urgent public health concern. With limited drug discovery solutions foreseeable in the immediate future, and with evidence that resistance can be ameliorated by optimisation of prescribing, focus currently centres on antibiotic use. In hospitals, this is manifest in the development of stewardship programs that aim to alter doctors' prescribing behaviour. Yet, in many clinical contexts, doctors' antibiotic prescribing continues to elude best practice. In this paper, drawing on qualitative interviews with 30 Australian hospital-based doctors in mid-2013, we draw on Bourdieu's theory of practice to illustrate that ‘sub-optimal’ antibiotic prescribing is a logical choice within the habitus of the social world of the hospital. That is, the rules of the game within the field are heavily weighted in favour of the management of immediate clinical risks, reputation and concordance with peer practice vis-à-vis longer-term population consequences. Antimicrobial resistance is thus a principal of limited significance in the hospital. We conclude that understanding the habitus of the hospital and the logics underpinning practice is a critical step toward developing governance practices that can respond to clinically ‘sub-optimal’ antibiotic use.

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  • Broom, Alex & Broom, Jennifer & Kirby, Emma, 2014. "Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing," Social Science & Medicine, Elsevier, vol. 110(C), pages 81-88.
    • Handle: RePEc:eee:socmed:v:110:y:2014:i:c:p:81-88
    DOI: 10.1016/j.socscimed.2014.03.030
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    References listed on IDEAS

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    1. Henriksen, Kristin & Hansen, Ebba Holme, 2004. "The threatened self: general practitioners' self-perception in relation to prescribing medicine," Social Science & Medicine, Elsevier, vol. 59(1), pages 47-55, July.
    2. Heritage, John & Stivers, Tanya, 1999. "Online commentary in acute medical visits: a method of shaping patient expectations," Social Science & Medicine, Elsevier, vol. 49(11), pages 1501-1517, December.
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    Cited by:

    1. Aaron Martin & Timothy B Gravelle & Erik Baekkeskov & Jenny Lewis & Yoshi Kashima, 2019. "Enlisting the support of trusted sources to tackle policy problems: The case of antimicrobial resistance," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-9, March.
    2. Armstrong, Natalie & Hilton, Paul, 2014. "Doing diagnosis: Whether and how clinicians use a diagnostic tool of uncertain clinical utility," Social Science & Medicine, Elsevier, vol. 120(C), pages 208-214.
    3. Kamenshchikova, A. & Wolffs, P.F.G. & Hoebe, C.J. & Penders, J. & Horstman, K., 2018. "Complex narratives of health, stigma and control: Antimicrobial resistance screening among non-hospitalized refugees," Social Science & Medicine, Elsevier, vol. 212(C), pages 43-49.
    4. Wang, Sophie Y. & Cantarelli, Paola & Groene, Oliver & Stargardt, Tom & Belle, Nicola, 2023. "Patient expectations do matter - Experimental evidence on antibiotic prescribing decisions among hospital-based physicians," Health Policy, Elsevier, vol. 128(C), pages 11-17.
    5. Broom, Alex & Kenny, Katherine & Kirby, Emma & Davis, Mark & Dodds, Susan & Post, Jeffrey & Broom, Jennifer, 2021. "The modern hospital executive, micro improvements, and the rise of antimicrobial resistance," Social Science & Medicine, Elsevier, vol. 285(C).
    6. Broom, Alex & Doron, Assa, 2022. "Resistant bugs, porous borders and ecologies of care in India," Social Science & Medicine, Elsevier, vol. 292(C).
    7. Broom, Alex & Broom, Jennifer & Kirby, Emma & Scambler, Graham, 2015. "The path of least resistance? Jurisdictions, responsibility and professional asymmetries in pharmacists' accounts of antibiotic decisions in hospitals," Social Science & Medicine, Elsevier, vol. 146(C), pages 95-103.
    8. Rynkiewich, Katharina & Gole, Sarin & Won, Sarah & Schwartz, David N., 2023. "Cultures of antibiotic prescribing in medical intensive care," Social Science & Medicine, Elsevier, vol. 324(C).
    9. Cabral, Christie & Lucas, Patricia J. & Ingram, Jenny & Hay, Alastair D. & Horwood, Jeremy, 2015. "“It's safer to …” parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies," Social Science & Medicine, Elsevier, vol. 136, pages 156-164.
    10. Carlsson, Fredrik & Jacobsson, Gunnar & Lampi, Elina & Rönnestrand, Björn, 2021. "Peers, policy, and attitudes as drivers of antibiotic prescribing," Working Papers in Economics 803, University of Gothenburg, Department of Economics.
    11. Gautham, Meenakshi & Spicer, Neil & Chatterjee, Soumyadip & Goodman, Catherine, 2021. "What are the challenges for antibiotic stewardship at the community level? An analysis of the drivers of antibiotic provision by informal healthcare providers in rural India," Social Science & Medicine, Elsevier, vol. 275(C).

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