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In the U.S. multidisciplinary pediatric pain clinic where I conducted 18 months of fieldwork, a widely held explanatory model tied the neurobiology of intractable pain to certain features of pervasive developmental disorders (PDD) such as concrete thinking, an interest in details, and hyper-attentiveness. Clinicians used terms such as 'sticky brains' and 'sticky neurons' to describe the perseverative thoughts and quirky behavior that characterized a sizable subset of the program's chronic pain patients who were believed to show signs of PDD, and consequently, did not respond well to treatment. Drawing on observations of clinical consultations, team meetings, and interviews with clinicians and families, I examine the meta-discursive processes by which clinical difficulties were inscribed onto difficult patients. Specifically, I demonstrate how discourse on sticky brains worked to re-classify challenging patients as psychologically abnormal, rationalizing their failed response to standard treatment. I argue that 'stickiness' provides an appropriate metaphor not only for a particular neurobiological configuration, but also for challenging clinical encounters. By illuminating the interactional processes through which clinical difficulties are managed, interpreted, and explained, the paper advances anthropological theorizing on the performative work of diagnosis and institutionalized misrecognition. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) continues to present a challenge to international healthcare systems and structures of public health. The focus on optimizing antibiotic prescribing in human populations has challenged healthcare systems charged with making responsible their physician-prescribers. In the United States, physicians in almost every specialty and role use antibiotics as part of their therapeutic armamentariums. In United States hospitals, most patients are administered antibiotics during their stay. Therefore, antibiotic prescribing and utilization is a commonly accepted part of medical practice. In this paper, we utilize social science work on antibiotic prescribing to examine a critical space of care in United States hospital settings. From March to August 2018, we used ethnographic methods to study hospital-based medical intensive care unit physicians at the offices and hospital floors they frequent in two urban United States teaching hospitals. We focused on eliciting the interactions and discussions surrounding antibiotic decision-making that are uniquely influenced by the context of medical intensive care units. We argue that antibiotic use in the medical intensive care units under study was shaped by urgency, hierarchy, and uncertainty representative of the medical intensive care unit's role within the larger hospital system. We conclude that by studying the culture of antibiotic prescribing in medical intensive care units, we can see more clearly both the vulnerability of the looming antimicrobial resistance crisis and by contrast the perceived insignificance of stewarding antibiotic use when considered alongside the fragility of life amidst acute medical concerns regularly experienced in the unit. • Antibiotic prescribing in the intensive care unit was shaped by existing workflows. • The pressure to treat patients in an urgent manner led to increased antibiotic use. • Felt urgency combined with complicated patient cases fostered uncertainty. • Participants recognized an interconnectedness with other teams working in the unit. • Participants used timeliness as a rationale for antibiotic prescribing. [ABSTRACT FROM AUTHOR]