ABSTRACT

Policies intended to reduce unnecessary use of antibiotics have been promoted as a key to preventing antimicrobial resistance. However, reduction of antibiotic use in health care potentially involves tensions between health of the patient receiving care and the health of the (future) population. An analysis of general practitioners’ talk about everyday medical practice in relation to respiratory tract infections shows how they manage to move between policy and patient interests through ‘alignment work.’ Alignment work is the discursive strategies used to manage risks and demands related to antibiotic resistance as well as patients receiving health care. Through alignment work conflicting demands and risks can be juggled, and antibiotic prescribing becomes discursively doable. Alignment work is not solely a matter of making conflicting demands and risks coherent, but might also involve leaving tensions and ambiguities intact. It enables general practitioners to align with AMR policy and the imperative of being restrictive with antibiotics, while still managing the risks threatening individual patients. As a consequence, lapses from AMR policy do not necessarily undermine it, but can instead be crucial to allowing the policy to work in the context of actual medical practice and, as such, be crucial to the overall success of the policy.

摘要

旨在减少不必要使用抗生素的政策已经得到了推广，这是预防抗菌素耐药性的关键。但是，减少医疗保健中的抗生素使用量可能会涉及接受治疗的患者的健康状况与（未来）人群的健康状况之间的紧张关系。对全科医师有关呼吸道感染的日常医疗实践的讨论的分析表明，他们如何通过“协调工作”设法在政策和患者利益之间转移。协调工作是用于管理与抗生素耐药性有关的风险和需求以及接受医疗保健的患者的话语策略。通过协调工作，可以解决相互矛盾的需求和风险，并且抗生素处方也变得可行。协调工作不仅是使冲突的需求和风险连贯一致的问题，而且还可能涉及保持紧张局势和歧义。它使全科医生能够遵守AMR政策以及限制使用抗生素的必要性，同时仍然可以管理威胁个别患者的风险。因此，AMR政策的遗漏并不一定会破坏它，而对于允许该政策在实际医疗实践中发挥作用至关重要，因此，对于该政策的整体成功至关重要。