Claiming or abdicating medical authority: Treatment recommendation actions, doctor-patient relationship, and antibiotic overprescription in Chinese paediatrics

Sociol Health Illn. 2024 May;46(4):722-743. doi: 10.1111/1467-9566.13733. Epub 2023 Dec 8.

Abstract

Antibiotic overprescription in China has long been considered a problem on the supply side, linked to the financial incentives of physicians. Based on the conversation analysis of 187 video-recorded naturally occurring medical consultations in Chinese paediatric primary care settings, this study finds that the driving force behind the problem of antibiotic overprescription in China has changed. Physicians use a low-authority communication style to recommend treatment, displaying a low level of medical authority and a willingness to accommodate caregivers' preferences in antibiotic prescribing decisions. The problem is now attributed to physician-caregiver interaction, doctor-patient relationship and the antibiotic-saturated prescribing culture. Practice implications involve deepening the understanding of the evolving nature of the antibiotic overprescription problem in China, building trust between physicians and patients/caregivers in order to facilitate the physicians' role as the gatekeeper of antibiotics and providing training programmes to help physicians develop effective communication skills.

Keywords: China; antibiotic overprescription; conversation analysis; doctor‐patient relationship; medical communication.

MeSH terms

  • Anti-Bacterial Agents* / therapeutic use
  • Child
  • Child, Preschool
  • China
  • Communication*
  • East Asian People
  • Female
  • Humans
  • Inappropriate Prescribing
  • Infant
  • Male
  • Pediatrics
  • Physician-Patient Relations*
  • Practice Patterns, Physicians'*
  • Primary Health Care