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Going shopping or consulting in medical visits: Caregivers’ roles in pediatric antibiotic prescribing in China

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  • Wang, Nan Christine
  • Liu, Yuetong

Abstract

Antimicrobial Resistance (AMR) is one of the gravest global public health crises today. Over-prescription in clinical settings is a primary driver. Despite its magnitude and scale, the problem of antibiotic over-prescription in China has not been understood adequately nor addressed effectively. Based on a corpus of 183 video-recorded medical conversations in the Chinese pediatric setting, we show that patient caregivers frequently challenge the physician's medical authority by resisting treatment recommendations, displaying a high level of entitlement to influence the treatment decision. As a result, even when the physicians do not recommend antibiotics based on their professional judgment, they prescribe in response to caregiver pressure. We argue that the relatively low level of medical authority is a significant contributor to the problem. Under this consumerist model of doctor-patient relationship, antibiotics are oriented to by the caregivers as a negotiable commodity and physicians are unable to fulfill their role as gatekeepers. Educational campaigns are needed to promote rational use of antibiotics among patients and caregivers, and serious efforts are called for to protect physicians' professional authority in China.

Suggested Citation

  • Wang, Nan Christine & Liu, Yuetong, 2021. "Going shopping or consulting in medical visits: Caregivers’ roles in pediatric antibiotic prescribing in China," Social Science & Medicine, Elsevier, vol. 290(C).
    • Handle: RePEc:eee:socmed:v:290:y:2021:i:c:s027795362100407x
    DOI: 10.1016/j.socscimed.2021.114075
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    References listed on IDEAS

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    1. Currie, Janet & Lin, Wanchuan & Zhang, Wei, 2011. "Patient knowledge and antibiotic abuse: Evidence from an audit study in China," Journal of Health Economics, Elsevier, vol. 30(5), pages 933-949.
    2. Wang, Nan Christine, 2020. "Understanding antibiotic overprescribing in China: A conversation analysis approach," Social Science & Medicine, Elsevier, vol. 262(C).
    3. He, Alex Jingwei, 2014. "The doctor–patient relationship, defensive medicine and overprescription in Chinese public hospitals: Evidence from a cross-sectional survey in Shenzhen city," Social Science & Medicine, Elsevier, vol. 123(C), pages 64-71.
    4. Stivers, Tanya, 2005. "Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance," Social Science & Medicine, Elsevier, vol. 60(5), pages 949-964, March.
    5. Stivers, Tanya, 2002. "Participating in decisions about treatment: overt parent pressure for antibiotic medication in pediatric encounters," Social Science & Medicine, Elsevier, vol. 54(7), pages 1111-1130, April.
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    1. Stivers, Tanya & Timmermans, Stefan, 2021. "Arriving at no: Patient pressure to prescribe antibiotics and physicians’ responses," Social Science & Medicine, Elsevier, vol. 290(C).
    2. Toerien, Merran, 2021. "When do patients exercise their right to refuse treatment? A conversation analytic study of decision-making trajectories in UK neurology outpatient consultations," Social Science & Medicine, Elsevier, vol. 290(C).

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