Patient violence and and antibiotic abuse: Evidence from China

Antibiotic abuse poses a critical public health challenge in China, with existing literature primarily emphasizing physicians' economic incentives as the driving force. This paper identifies a novel mechanism: patient violence as a catalyst for defensive antibiotic prescribing. Leveraging a violent incident at a top-tier Beijing hospital with a 95% patient satisfaction rating, we analyze over 67,000 electronic consultation records from an online platform where physicians' income derives solely from service fees-effectively isolating economic incentives from prescribing behavior. Using a difference-in-differences framework with physician and time fixed effects, we find that physicians in the affected department increase antibiotic prescriptions by 11.4 percentage points and non-prescription antibiotic guidance by 11.3 percentage points following the incident. These effects concentrate among patients expressing recovery expectations, with no significant impact on other patients, and decay within one week. Our findings reveal "appeasement behavior" as a distinct form of defensive medicine-physicians accommodate patient demands to mitigate conflict risk when clinical relationships become strained. The results underscore that antibiotic abuse is not solely an economic phenomenon but also a behavioral response to workplace violence, with important implications for antibiotic stewardship programs and patient safety policies.