Ethical dilemmas in antibiotic prescribing: analysis of everyday practice

Abstract

Balancing of pros and cons was prominent in our informants' decision making but often resulted in decisions that deviated from the ethical guidance. The ranking varied much between the GPs. The highest priorities in the GPs' practice were related to the patient's everyday life (sometimes autonomy, sometimes beneficence in a broad sense), doctor-patient relationship (communication competence), the patient's perceived importance on the job market (society) and relationship with colleagues (fraternal). Perceived lack of resources and uncertainty with respect to both diagnostic and treatment decisions frequently influenced decision making.

What are the non-biomedical reasons which make family doctors over-prescribe antibiotics for upper respiratory tract infection in a mixed private/public Asian setting?

“…This is consistent with previous reports that physicians are more likely to prescribe antibiotics if they perceive that patients expect antibiotics (12). This presents ethical dilemmas for the physicians (15) and confirms the importance of public education on the use of antibiotics, in particular on URTI. This is the most common illness in the community and, in the majority of cases, will not benefit from antibiotic therapy (16).…”

Uncomfortable prescribing decisions in hospitals: the impact of teamwork

“…2,4 Theoretical explanations for such etiquette include the existence of 'fraternal obligation', 20 in which doctors will work in the spirit of other doctors, to the extent that it can deviate from their own ideals. 21 Prescribing etiquette, unfortunately, has been found to be a cause of inappropriate prescribing. 22 The behaviour reported in this study could potentially result in the emergence of inappropriate prescribing decisions originating from hospital care.…”

Antibiotic prescribing for the future: exploring the attitudes of trainees in general practice

“…This 'balancing' of scientific and practical considerations, including their relationship with the patient, colleagues, and society, and the impact of diagnostic uncertainty has been demonstrated in other studies of established GPs. 15 Registrars describe feeling disappointed in themselves for prescribing contrary to their ideals. The impact of these decisions on a prescriber's self-perception, and the variety of coping strategies that are employed have been explored in other studies.…”