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

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.

Pre-Visit Use of Non-Prescribed Antibiotics among Child Patients in China: Prevalence, Predictors, and Association with Physicians' Prescribing of Antibiotics at Medical Visits.

Antibiotic resistance is one of the most serious global public health crises. Inappropriate use of antibiotics is an important contributor. Using a cross-sectional survey, we recruited 3056 caregivers from 21 provinces in China to complete a questionnaire pertaining to their most recent medical visits for children's acute respiratory tract infection (ARTI) symptoms in October 2013. The findings show that the prevalence of caregivers giving children non-prescribed antibiotics before their medical visit was as high as 38%. Caring for an older child and having lower educational attainment increased the likelihood of self-medication with antibiotics; among Chinese residential areas, caregivers living in tier 2 urban districts were most likely to administer non-prescribed antibiotics before their visit. Physicians' prescribing of antibiotics was significantly associated with caregivers' self-reported pre-visit use of non-prescribed antibiotics. Misuse should be addressed by regulating the sale of antibiotics and improving communication at medical consultations.

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

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.

Understanding antibiotic overprescribing in China: A conversation analysis approach.

Antibiotic resistance and its associated overprescription constitute one of the biggest global public health crises nowadays. Although widely recognized in high-income countries, the problem has not received enough attention and is not understood in the context of middle- and low-income countries. In this study, using a conversation analysis (CA) approach, I examine the antibiotic treatment decisions in naturally occurring medical encounters in China. The results show that, contrary to the prevailing theory of the physician incentive structure as the sole driver, antibiotic overprescription can be interactively achieved and significantly influenced by patients and caregivers in medical encounters. This suggests that management of patient caregivers' expectations for antibiotic treatment and the training of physicians' interactional skills in responding to patient/caregiver pressure in medical interactions have great potential for curbing the problem of antibiotic overprescription in China.