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The Etiquette That Dictates Antibiotic Prescribing in Hospitals

Summary and Comment |
August 1, 2013

The Etiquette That Dictates Antibiotic Prescribing in Hospitals

  1. Abigail Zuger, MD

Evidence-based data are no match for instinct and habit.

  1. Abigail Zuger, MD

Misjudgments in antibiotic prescribing contribute to a variety of clinical ills, from bad patient outcomes to high rates of drug resistance and soaring healthcare costs. However, despite clinical infectious disease and pharmacy consultants, not to mention widely available guidelines covering most clinical circumstances, poor prescribing habits persist.

British researchers conducted face-to-face structured interviews with 39 staff members (10 doctors, 10 pharmacists, 18 nurses, and 1 midwife) at four affiliated London hospitals and solicited their observations about antibiotic prescribing. Analysis of the interviews using a standard sociologic approach to qualitative data revealed a prevailing “prescribing etiquette.” In it, senior doctors felt complete autonomy to prescribe what they wanted and were loath to interfere in the prescribing decisions of their colleagues, with the justification that they believed evidence-based policies to be inapplicable in specific clinical circumstances. A hierarchical culture dictated that, although “junior doctors” (the British equivalent of U.S. residents and fellows) might do the actual prescribing of antibiotics, decisions about what to prescribe were made by senior doctors.

Comment

Despite the limitations of this subjective, nonvalidated data, the findings certainly ring true for hospitals on this side of the ocean as well. The authors make the convincing case that, for things to change, antibiotic education should be directed not at house staff but at their attendings.

  • Disclosures for Abigail Zuger, MD at time of publication Editorial boards Journal Watch AIDS Clinical Care; Clinical Infectious Diseases Other New York Times medical writer

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