title: Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing.
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.
authors.affiliation: School of Social Science, University of Queensland, St Lucia, QLD 4072, Australia. Electronic address: a.broom@uq.edu.au.
authors.forename: Alex
authors.initials: A
authors.lastname: Broom
authors.affiliation: Department of Medicine, Nambour Hospital, QLD, Australia. Electronic address: jennifer.broom@health.qld.gov.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Broom
authors.affiliation: School of Social Science, University of Queensland, St Lucia, QLD 4072, Australia. Electronic address: e.kirby@uq.edu.au.
authors.forename: Emma
authors.initials: E
authors.lastname: Kirby
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001315:Australia; D002755:Choice Behavior; D005260:Female; D020445:Hospitalists / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015279:Organizational Culture; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011582:Psychological Theory; D036301:Qualitative Research
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Australia; Hospital medicine; Infection control; Prescribing; Qualitative interviews