Struggles Over Antibiotics: Physicians’ stance-taking toward an off-line clinical policy in an Intensive Care Unit

• In Event: Making Knowledge Relevant in Medical and Mediated Contexts

Abstract

One of the most pressing contemporary healthcare challenges consists in rethinking antibiotic use to contrast the increase of multi-drug resistant bacteria. Drawing on an ethnographic field-work in an Intensive Care Unit that adopts a non-conforming policy of antibiotic stewardship, this article analyzes doctor-doctor interaction concerning infectious disease diagnosis and anti-biotic treatment. By analyzing examples of medical decision-making from a corpus of video-recorded morning briefings, we focus on physicians’ stance-taking towards the ward’s non-conforming 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 an interactional highly reflective achievement by the team.
(positioning, doctor-doctor interaction, conversational analysis, Stance-taking; alignment, antibiotic treatment, decision-making)

Authors

• Letizia Caronia, Department of Education U of Bologna

• Arturo Chieregato, Niguarda Hospital (Milan, Italy)

• Marzia Saglietti, University of Bologna