Struggles Over Antibiotics: Physicians' Stance-Taking Toward a Nonconforming Policy in an Intensive Care Unit

One of the most pressing contemporary health care challenges consists in rethinking antibiotic use to contrast the increase of multidrug resistant bacteria. Drawing on an ethnographic fieldwork in an Intensive Care Unit that adopts a nonconforming policy of antibiotic stewardship, this article analyzes doctor-doctor interaction concerning infectious disease diagnosis and antibiotic treatment. By analyzing examples of medical decision-making from a corpus of video-recorded morning briefings, we focus on physicians' stance-taking toward the ward's nonconforming policy and illustrate how it is contingently situated along a continuum from strong commitment to overt resistance. We suggest that physicians' oscillating stance-taking is favored by the moral load of following an extreme and "off-label" policy and, in turn, impacts on the way this policy is practically accomplished as a highly reflective interactional achievement by the team members.