Differences between medical and surgical teams on antibiotic use

Decision making in antibiotic use is conditioned by cultural and social determinants. A paper evaluated acute medical and acute surgical teams at a London teaching hospital using ethnographic techniques (i.e., a qualitative study approach). The conclusions of the study were that in surgery, the antibiotic treatment is perceived as nonsurgical intervention and delegated to junior team members, because senior surgeons are notably absent from wards – they prefer to be in the operating room. This fact leads to defensive antibiotic prescriptions and prolonged and inadequate antibiotic use. Different approaches should be taken to surgical and clinical teams.

Szymeczak commentary begins with an old joke:

Four doctors go duck hunting: an internist, an emergency medicine physician, a surgeon and a pathologist. A bird flies overhead. The internist looks at the bird, studies it and says,  “Notice  the webbed feet, distinctive plumage and quacking sound, so probably we have seen a duck, but we need more data – and he forgets to shoot. A new bird flies: the ER doctor says: it’s a goose! it’s a duck! No, It’s a swan! No, it’s definitely a duck! He shoots five times and misses all the shots. The bird flies away. Again, a new bird flies, the surgeon shoots. The bird falls to the ground and the surgeon turns to the pathologist and says, go there and tell me if it’s a duck. (a Brazilian adaptation of this joke follows: the pathologist gets the carcass and says: there is not enough material to conclude). Szymeczak discusses professional stereotypes and concludes that they have some relevance. She thinks that the type of research done by Charani et al is important, as well as the adequate tactics to guarantee the appropriate use of antibiotic tailored to sociological and cultural factors. The end of her commentary is to the point: surgeons are different – it does not take a duck hunt to figure that out.

An additional comment of the Scientific Editor of this journal: Qualitative studies with quality and rigor are rare and hardly published in appropriate adequate peer-reviewed journals.


Charani E, Ahmad R, Rawson TM, Castro-Sanchèz E, Tarrant C, Holmes AH.

The diferences in antibiotic decision-making between acute surgical and acute medical teams: an ethnographic study of culture and team dynamics.

Clin Infect Dis. 2019;69(1):12-20. https://doi.org/10.1093/cid/ciy844.


Commentary about this paper:

Szymeczak JE. Are surgeons different ? The case for bespoke antimicrobial stewrship. Clin Infect Dis. 2019;69(1):21-3. https://doi.org/10.1093/cid/ciy847.

Differences between medical and surgical teams on antibiotic use