Alignment Work : Medical Practice in Managing Antimicrobial Resistance

Policies intended to reduce unnecessary use of antibiotics have been promoted as a key to preventing antimicrobial resistance. However, reduction of antibiotic use in health care potentially involves tensions between health of the patient receiving care and the health of the (future) population. An analysis of general practitioners’ talk about everyday medical practice in relation to respiratory tract infections shows how they manage to move between policy and patient interests through ‘alignment work.’ Alignment work is the discursive strategies used to manage risks and demands related to antibiotic resistance as well as patients receiving health care. Through alignment work conflicting demands and risks can be juggled, and antibiotic prescribing becomes discursively doable. Alignment work is not solely a matter of making conflicting demands and risks coherent, but might also involve leaving tensions and ambiguities intact. It enables general practitioners to align with AMR policy and the imperative of being restrictive with antibiotics, while still managing the risks threatening individual patients. As a consequence, lapses from AMR policy do not necessarily undermine it, but can instead be crucial to allowing the policy to work in the context of actual medical practice and, as such, be crucial to the overall success of the policy.