Does it Matter What Time of Day You See Your Oncologist?

A new study out of Boston demonstrates a tendency among physicians to make different, less rigorous clinical decisions in the later hours of the day compared to the early hours.

The team begins this study by making the following statement:

Clinicians make many patient care decisions each day. The cumulative cognitive demand of these decisions may erode clinicians’ abilities to resist making potentially inappropriate choices. Psychologists, who refer to the erosion of self-control after making repeated decisions as decision fatigue have found evidence that it affects nonmedical professionals. For example, as court sessions wear on, judges are more likely to deny parole, the “easier” or “safer” option.

With that inauspicious beginning, Jeffrey A. Linder of Brigham and Women's Hospital in Boston and colleagues launch into a study in which they analyzed the diagnosis of acute respiratory infections in nearly 22,000 cases over a time frame of 18 months.

What they found was that the likelihood among these clinicians to prescribe antibiotics went up as the day wore on—whether or not antibiotics were actually indicated by the patient's symptoms. 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.

Linder told the New York Times that doctors "may be fatigued and make worse decisions toward the end of our clinic sessions."

While the study itself involved primary care physicians, nurse practitioners, and even some physician trainees, it doesn't take a stretch of the imagination or a reinterpretation of the results to believe that decision fatigue has just as much likelihood to affect the decisions made by oncologists, especially when one considers how much career burn-out can be found among this group of doctors.

"The radical notion here is that doctors are people too," added Linder, a comment I read as a sad attempt to justify laziness.

Does this mean that you should always see your oncologist in the morning hours? No, it doesn't necessarily mean that, especially since that's simply not possible for many patients. But it should serve as a reminder that your appointment time with your doctor is far more important to you than it is to him or her, and that it is ultimately up to you the patient to take an active role in getting the most out of your physician's care.

Sources:
Time of Day and the Decision to Prescribe Antibiotics
NYT: Doctors and Decision Fatigue