Paper short abstract:

In therapeutic encounters between clinicians and parents of children with cough both evaluate the credibility of the other. Trust and credibility are key to the success of these encounters and their lack may contribute to higher antibiotic prescribing rates.

Paper long abstract:

Respiratory tract infections (RTI) are the most common reason for parents to take their child to a clinician. Antibiotics are frequently prescribed for RTI in children, contributing to the development of antimicrobial resistance (AMR). Drawing on empirical data from connected studies with parents and clinicians about consultations for children with RTI, I will examine the key role played by trust and credibility in these therapeutic encounters. When parents consult for a child with a RTI, they assess the credibility of the medical evaluation carried out by the clinician. Credibility is judged on whether or not clinicians are perceived as listening to and taking seriously the parent's description of their child's illness and whether or not the physical examination conforms to the parent's expectations. If parents judge that a medical evaluation is not credible, they distrust the diagnosis and treatment advice and view the consultation as a wasted encounter, often re-consulting a different clinician or at a different service (e.g. A&E). A minority of parents also miss-trust clinician's rationale for not prescribing antibiotics. Drawing on public discourses about the need for rationing in the NHS, they believe that when clinicians decide not to prescribe antibiotics, it is because clinicians are saving the antibiotics for worse cases or the vulnerable elderly. In their turn, clinicians evaluate the competence of parents to manage a child with RTI, in particular to spot signs of deterioration. If they do not trust a parent to re-consult if needed, they prescribe antibiotics just in case.