Table 2

Clinician characteristics influencing clinicians’ antibiotic prescribing

FeatureDescriptionExtractExtract number
Clinicians’ professional ethosReceptivenessOld habits die hard [...] even when new guidelines are implemented I find it difficult to put these into practice. I am so used to the old ways (Utrecht 72)7
School of thoughtI've always been a bit reserved, because my Professor back... already made us understand good and proper that you have to be very careful with that stuff ((antibiotics)) (Antwerp 77)8
Self belief in decision-makingTolerating uncertaintyI think what also plays a role is the feeling of the doctor, it feels somewhat safer to let the patient go home with antibiotics than without antibiotics […] Well, you think, if there still is something wrong and it actually is a bacterial infection, of which someone could also die (Utrecht 16)9
ConfidenceI struggle to an extent with my confidence at not giving antibiotics and with patient expectation to give antibiotics. Um, but I think that we're in a climate where antibiotic prescribing is reducing as people [...] are more amenable to the idea that an antibiotic may not be necessary. But I think the threshold at which one uses them is still something that I feel that I slightly struggle with (Southampton 43)10
When one is younger one is usually, maybe correctly so, or maybe incorrectly so, one is a bit more uncertain and tends to rely more heavily on diagnostic testing. As one gets older one tends to be a bit more self-confident and may reason ‘well I've seen so many similar situations before, I'm fairly sure of my diagnosis’ (Milan 65)11
Commitment to shared decision-makingSharing responsibilityThe image of the doctor really has changed over time, hasn't it?! I can tell the patient what I think would be the correct treatment, but I can't force them…The patient is the one who decides (Barcelona 115)12
Confrontation thresholdIf patients really insist and if you will really end up with an unpleasant conflict if you do not give in, then you do give way every once and a while (Utrecht 100)13
Emotional investmentAt the beginning …I had a greater enthusiasm in dissuading the patient…in explaining him that the antibiotic is not necessary with relation to what I do now (Łódź 78)14
Some say give me antibiotics…I still do the effort of explaining it to them, like I say you mean antibiotics, don't you. But in this case it's more likely that they will cure you later instead of sooner. They don't help for this kind of infections, viruses, and if you give antibiotics for things they are not meant for, then, in the end, you only suffer from the side effects and you'll be sick even longer…But then you really have to bother to explain, ‘cause it's far more difficult not to prescribe antibiotics, than to prescribe them (Antwerp 77)15