Role crisis, risk and trust in Australian general public narratives about antibiotic use and antimicrobial resistance

Abstract

As antibiotics have become increasingly ineffective against bacteria, antibiotic stewardship has been introduced across a variety of settings world-wide. Members of the public have been entreated to use antibiotics strictly as prescribed. We interviewed ninety-nine participants who shared their understandings of antibiotics and reflections on antibiotic resistant bacteria. Some participants were eager consumers of antibiotics whilst others sought to avoid them. Overall, the participants expressed their desire to act in a responsible manner in relation to antibiotic usage. However, we also found considerable confusion regarding responsible action linked with risk management and trust in expert advice. Despite the encouragement of personal responsibility for health decisions, sick individuals are urged to enact a Parsonian-like sick role that abdicates personal decision-making powers and invests trust in the expertise of prescribers. We find this assumption of a responsible, knowledgeable patient and expert clinician is disrupted by 1) patients’ contingencies when circumstances force them to seek and use antibiotics despite their misgivings, 2) patients’ own embodied knowledge and assessment of their vulnerability and progression of infections and 3) doubts in the expert knowledge of clinicians, as considered in light of scientific debate. Accordingly, lay publics are left entangled in contrary expectations of responsibility and trust regarding the use of antibiotics with significant implications for antimicrobial stewardship.