Does Your Doctor Suffer From Decision Fatigue?

Recently, Nicholas Bakalar of the New York Times blogged about the results of a study that appeared in the journal JAMA Internal Medicine, and the implications of this study touch everyone who sees a doctor.

The study, Time of Day and the Decision to Prescribe Antibiotics, begins by noting that men and women in serious professions can suffer from what psychologists describe as "the erosion of self-control after making repeated decisions," otherwise known as decision fatigue. For example, studies have shown that judges are more likely to grant parole in the morning; as the day wears on, they become more likely to deny parole (i.e., take the easier or safer option).

In the study, lead author Jeffery A. Linder of Brigham and Women's Hospital in Boston and colleagues analyzed the diagnoses of acute respiratory infections in almost 22,000 cases spanning 18 months. They found that clinicians' likelihood to prescribe antibiotics increased as the day wore on, no matter whether antibiotics were actually indicated for the illness or not. Compared to the first hour of the workday:

  • In the second hour, the probability of an antibiotics prescription rose by 1 percent.
  • In the third hour, it shot up to 14 percent.
  • In the fourth hour, it went all the way up to 26 percent.

"We may be fatigued and make worse decisions toward the end of our clinic sessions," Linder told the Times.

So the first takeaway from this study would probably be to schedule appointments with your physician early in the morning. But since not everyone can do this, those who visit doctors later in the day need to see to it that their doctor is reminded of why you're there so that you can get the best possible care.

"The radical notion here is that doctors are people too," Linder said, almost as a way to justify lazy clinical decisions. Whatever the case, it reminds us that the patient who gets the most out of his or her medical care is the one who actively participates in it.

Source: NYT: Doctors and Decision Fatigue

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