Governing Risk by Conveying Just Enough (Un)Certainty: Rearticulating Good Doctoring as a Psy-Medical Competence

  • Mads BankEmail author
  • Anne Rogne


This chapter is an ethnographic study using participant observations and interviews to explore how clinical encounters regarding possible antibiotic prescription are handled by GPs and patients, bringing attention to among others, meaning-making, different logics, ways of thinking, and affective states involved in this process. The study shows how much can be gained from moving beyond a sheer focus on knowing as well as qualities and competencies of GPs in order to include how patients’ affective states are governed in the ‘liminal zones of uncertainty’ that arise when no clear diagnosis to be treated can be given.


  1. Ackerman, S. L., Gonzales, R., Stahl, M. S., & Metlay, J. P. (2013). One size does not fit all: Evaluating an intervention to reduce antibiotic prescribing for acute bronchitis. BMC Health Services Research, 13(1), 462.CrossRefGoogle Scholar
  2. Cordoba, G., Siersma, V., Lopez-Valcarcel, B., Bjerrum, L., Llor, C., Aabenhus, R., & Makela, M. (2015). Prescribing style and variation in antibiotic prescriptions for sore throat: Cross-sectional study across six countries. BMC Family Practice, 16, 7.CrossRefGoogle Scholar
  3. Dean, M. (1999). Risk, calculable and incalculable. Risk and Sociological Theory: New Directions and Perspectives, 1(1998), 131–159.Google Scholar
  4. Duane, S., Domegan, C., Callan, A., Galvin, S., Cormican, M., Bennett, K., … Vellinga, A. (2016). Using qualitative insights to change practice: Exploring the culture of antibiotic prescribing and consumption for urinary tract infections. BMJ Open, 6(1), e008894.CrossRefGoogle Scholar
  5. Gonzalez-Gonzalez, C., López-Vázquez, P., Vázquez-Lago, J. M., Piñeiro-Lamas, M., Herdeiro, M. T., Arzamendi, P. C., & Figueiras, A. (2015). Effect of physicians’ attitudes and knowledge on the quality of antibiotic prescription: A cohort study. PLoS ONE, 10(10), 1–12.Google Scholar
  6. Greco, M. (1993). Psychosomatic subjects and the duty to be well: Personal agency within medical rationality. Economy and Society, 3(22), 357–372.CrossRefGoogle Scholar
  7. Greco, M. (2017). Pragmatics of explanation: Creative accountability in the care of ‘medically unexplained symptoms’. The Sociological Review, 65(2_Suppl), 110–129. CrossRefGoogle Scholar
  8. Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: The implementation of change in health care (2nd ed.). West Sussex: John Wiley & Sons.Google Scholar
  9. Hansen, M. P., Hoffmann, T. C., McCullough, A. R., van Driel, M. L., & Del Mar, C. B. (2015, February). Antibiotic resistance: What are the opportunities for primary care in alleviating the crisis? Front Public Health, 3(February), 35.Google Scholar
  10. Jakobsen, K. A., Melbye, H., Kelly, M. J., Ceynowa, C., Mölstad, S., Hood, K., & Butler, C. C. (2010). Influence of CRP testing and clinical findings on antibiotic prescribing in adults presenting with acute cough in primary care. Scandinavian Journal of Primary Health Care, 28(4), 229–236.CrossRefGoogle Scholar
  11. Jansbøl, K., Nielsen, A., Henriette, M., Jessica, M., Pia, L., & Kjellberg, K. (2012). Hvordan påvirker kliniske vejledninger almen praksis? Hvordan har kliniske vejledninger ændret almen praksis? (pp. 237–750). Månedsskrift for almen praksis, September 2012.Google Scholar
  12. Jørgensen, L. C., Friis Christensen, S., Cordoba Currea, G., Llor, C., & Bjerrum, L. (2013). Antibiotic prescribing in patients with acute rhinosinusitis is not in agreement with European recommendations. Scandinavian Journal of Primary Health Care, 31(2), 101–105.CrossRefGoogle Scholar
  13. Lopez-Vazquez, P., Vazquez-Lago, J. M., & Figueiras, A. (2012). Misprescription of antibiotics in primary care: A critical systematic review of its determinants. Journal of Evaluation in Clinical Practice, 18, 473–484.CrossRefGoogle Scholar
  14. Lupton, D. (2013). Risk (2nd ed.). London: Routledge.Google Scholar
  15. Massumi, B. (1993). The politics of everyday fear. Minneapolis: University of Minnesota Press.Google Scholar
  16. Mol, A. (2002). The body multiple: Ontology in medical practice. Durham and London: Duke University Press.CrossRefGoogle Scholar
  17. Mol, A. (2008). The logic of care: Health and the problem of patient choice. Oxon and New York: Routledge.Google Scholar
  18. Rodrigues, A. T., Ferreira, M., Roque, F., Falcão, A., Ramalheira, E., Figueiras, A., & Herdeiro, M. T. (2016). Physicians’ attitudes and knowledge concerning antibiotic prescription and resistance: Questionnaire development and reliability. BMC Infectious Diseases, 16(1), 7.CrossRefGoogle Scholar
  19. Stenner, P., & Moreno-Gabriel, E. (2013). Liminality and affectivity: The case of deceased organ donation. Subjectivity, 6(3), 229–253.CrossRefGoogle Scholar
  20. Stivers, T. (2007). Prescribing under pressure: Parent-physician conversations and antibiotics. Oxford: Oxford University Press.CrossRefGoogle Scholar
  21. Strandberg, E. L., Brorsson, A., Hagstam, C., Troein, M., & Hedin, K. (2013). “I’m Dr Jekyll and Mr Hyde”: Are GPs’ antibiotic prescribing patterns contextually dependent? A qualitative focus group study. Scandinavian Journal of Primary Health Care, 31(3), 158–165.CrossRefGoogle Scholar
  22. Timmermans, S., & Berg, M. (2003). The gold standard: The challenge of evidence-based medicine and standardization in health care. Philadelphia: Temple University Press.Google Scholar
  23. Tonkin-Crine, S., Walker, A. S., & Butler, C. C. (2015, June). Contribution of behavioural science to antibiotic stewardship. BMJ, 350(June), h3413.CrossRefGoogle Scholar
  24. Turner, V. (1995). The ritual process: Structure and anti-structure. Piscataway, NJ: Transaction Publishers.Google Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  1. 1.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
  2. 2.‘Psykologisk korttidsrådgivning’ (‘Psychological Counseling’) CopenhagenCopenhagenDenmark

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