Distributed Ignorance, Tricky Cases, and Low Hanging Fruit: Targeting Antibiotics and Treating Bladders

Uncomplicated urinary tract infection is usually understood to be easily resolved via the immune system or judicious use of antibiotics. Recently, this indication has become a major target of intervention around antimicrobial resistance. This chapter proceeds with a discussion of the visibility of patient groups gathering online to draw attention to persistent symptoms after treatment. Similar groups of patients have long been visible, demonstrating a history of complex experiences.

The chapter draws on an analysis of antimicrobial stewardship policy documents and a supplementary dataset of interviews with patients and clinicians in the United Kingdom. It might be expected that care of complex cases would be deferred to clinical judgement rather than coordinated in public health policy. However, employing Heimer’s (2012) concept of ‘distributed ignorance,’ the chapter traces parallel processes of distributed ignorance through which complex experiences are removed from the scope of both public health intervention and clinical care. A reduction of complexity is consistent across public health and clinical settings as attention is directed to ‘easy’ cases. By bringing these parallel processes of distributed ignorance together, the chapter explores the production of this patient group as ‘out of scope’ and considers how they might be brought back within scope.