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.