Table 4.
Key quotes from the FGDs and SSIs by theme
| Theme | Quote number | Quote | Participant |
|---|---|---|---|
| Understanding the CMS | 1.1 | Before, when we worked without microbiologists we used a lot of antibiotics, abused [emphasized] antibiotics … And now we use them more correctly … And we can know the organism grown, and we know the resistance, so we can use narrow spectrum antibiotics and minimize the cost to AHC. | senior doctor |
| 1.2 | I think the training, education we provide to physicians is important, so they know the important role of the microbiology service, to make sure they understand what is really useful about it and how it can help their practice to take care of the patient. | management | |
| 1.3 | First of all about blood cultures, how to be sterile, otherwise maybe there will be mixed growth. And another thing is to make sure that we thoroughly check the condition of the patient before we give antibiotics. It will be much better to reduce resistance or unnecessary use of antibiotics, also spending money for nothing. | junior doctor | |
| Comprehensive | 2.1 | We’ve got the microbiology team, and we’ve got the rounds two times a week, and we’ve got an on-call service so we can call them anytime. And we’ve got the facility that can grow the organisms, a reliable lab. And I think the micro team has developed guidelines for us. | management |
| 2.2 | You need to have a person who understands the way clinicians work, and understands the way the microbiology laboratory works. And then that person is just like a bridge to bring them together. You need to build a person in house to do that activity, it’s very important. | clinical microbiologist | |
| 2.3 | They know things we don’t know [laughter]. Mostly about organisms, like how they survive, how they kill, how the antibiotics work on them, the side-effects of antibiotics. | junior doctor | |
| Accessibility | 3.1 | I got a phone call from [name of microbiologist] when the patient grew Gram-negative bacteria and he told me that it might be melioidosis. The patient was treated with ceftriaxone, and then he called me to change it. And ultimately it was melioidosis. I could change it very fast because when he got the result he called me. | senior doctor |
| Trust | 4.1 | I think we have open lines of communication basically, and mutual trust. And that’s come with time and generation of results that seem to be useful … Our doors are always open and we can have open dialogue about problems as they come up. | clinical microbiologist |
| 4.2 | I think that MicroGuide is great for us because it is based on Cambodian research, not global research. | junior doctor | |
| Lack of clinical confidence | 5.1 | I think that if we have no microbiology to determine the pathogen, maybe we would still treat with blind reason on the clinical features. We would not be confident about source of infection, or the pathogen. | junior doctor |
| 5.2 | Sometimes the clinical picture does not fit the microbiology result. Like, the blood culture is positive but the clinical features of the patient do not fit, it doesn’t fit together. So we have to think again, to revise again …We have to discuss. Microbiologists come and we have to discuss together, and focus on the benefit to the patient. | senior doctor | |
| Hierarchy | 6.1 | So it is very difficult. I accept the ideas of the microbiologists, but we have no choice. | junior doctor |
| 6.2 | Because unless I’m happy, because the decision is made, in the end, is made by the people who are taking care of the patient … if you think that the idea [from microbiology] is right, and you accept it, you do it. But if you disagree and you think that you’re doing the right thing and the patient’s getting better, just keep on with that. | senior doctor | |
| Fixed beliefs and behaviours | 7.1 | Sometimes they [doctors] believe in this antibiotic, so they don’t want to change their behaviour. It’s not the problem of communication, it’s not the problem of the facility, but they just personally, yeah. And I appreciate that the micro team works hard, they generally try very hard to talk with the physicians, even when they don’t accept their advice but they try hard to explain it to them. | management |
| 7.2 | Sometimes, like at the private hospital, they prescribe because they can charge. You understand? They charge money. And also they can get benefits from the pharmaceutical company … For patients, their culture when they come to the hospital is that they need medicine. Mostly if we don’t prescribe antibiotics they don’t feel confident, they are not happy … So this is the challenge, to change this culture. | management | |
| 7.3 | We continue, we try, we will not stop doing, and we will continue providing our service. And we encourage them to understand, and I hope that the challenge will be reduced … I am a person to bridge, to narrow the gap between the clinicians bit by bit, bit by bit. And with time it’s going to be closer together. And people come to understand each other. | clinical microbiologist | |
| Communication | 8.1 | Sometimes the microbiologist doesn’t know everything, doesn’t know all the guidelines. But I suppose we can learn from each other. Because we learn a lot from him, but can he learn from us? | senior doctor |
| 8.2 | Yeah, saving face, it’s a critical part of cultural interactions here. It’s very bad form to criticize somebody directly and make them feel or appear incorrect or wrong or less knowledgeable, than their status would predict. So that really limits the direct challenging of a doctor’s diagnosis or a treatment plan that can be done. | clinical microbiologist | |
| 8.3 | [Referring to differing opinions of microbiologists and physicians] We are different people, different concepts, different ideas and opinions. We don’t totally agree with each other, so we need to find one solution that is appropriate for most partners. | senior doctor |