Zoey Agle, Class of 2021
When you have to make a doctor’s appointment, I’m sure you primarily think about
scheduling it so it doesn’t interfere with your work, school, and other plans. You likely don’t worry about whether your appointment time will affect the medical care you receive, but maybe you should.
Recent research has shown that as the work day goes on, and as appointments fall further and further behind, the quality of care patients receive from their doctor goes down. One study found that physicians were more likely to prescribe antibiotics to patients seen later in the day (Linder et al. 2014). Another found that opioid prescriptions also increased with later appointments. In fact, the researchers stated that if opioid prescriptions had been consistent from the first appointment of the day, there would have been almost 4500 fewer opioid prescriptions ordered in 2017 alone (Neprash and Barnett 2019). While easy fix prescriptions increased over the course of the day, preventative care measures decreased, like flu vaccinations and orders for mammograms.
It is suspected that these trends are seen because doctors are weary later in the day. These preventative measures or pain treatments, which are not easy fixes to patients’ problems, require time for the doctor and patient to sit down and have a conversation (Gordon 2020). This can also explain why the trends correlate with appointments running behind schedule. Having to explain to a patient in pain how physical therapy may be a good option for them though the results are not immediate, can seem like it will not fit into a doctor’s chaotic schedule. Instead they acknowledge the patient’s pain and prescribe opioid painkillers, showing the patient that they take their symptoms seriously.
Another proposed reason for deteriorating care throughout the day is decision fatigue. Decision fatigue is the declining of self-control as you continue to make decisions throughout the day. Medicine isn’t the only field that may be facing the harm of decision fatigue. Data has shown that as the day goes on, judges are less likely to grant parole. Choosing to grant parole requires more thought about the intricacies of the case than just deciding to deny it (Linder et al. 2014). After already having seen a multitude of patients all with different ailments and symptoms, it is certainly plausible that a doctor’s ability to make informed, complex decisions will be diminished, causing them to just pick the easy way to alleviate a patient’s symptoms.
There is also the argument that a patient’s own decision fatigue could be contributing to this issue. Patients are coming into doctors’ offices for their appointment after having spent their own days having to make decisions at work, at home, while running errands, etc. When their doctor comes in and tells them that they are due for a cancer screening or that flu season is beginning, the idea of having to schedule an uncomfortable procedure or get stuck by a needle may just seem exhausting (Gordon 2020). Instead, they tell the doctor they would rather wait and discuss it during their next appointment.
The studies that found these trends in medical care have proposed some solutions to the end of the day weariness, time crunch, and decision fatigue that may be contributing to a deterioration in patient care. One such proposal is that medical assistants, in lieu of doctors, could be put in charge of discussing and ordering screening tests for patients, which the doctor will then approve. These tasks do not require the doctor to be present, so it would allow them to spend their time with patients focusing more on the nuanced care of injury and illness (Gordon 2020). There are some other easy modifications that could be made to a doctor’s schedule to help
reduce the strain they feel later in the day, like adding mandatory breaks and pausing to have snacks (Linder et al. 2014). The next step is to put these adjustments to the test to see if they have their desired effect.
While these results may seem a bit scary as a patient, the fact that this research is being done is a good sign that the problems are being acknowledged and that remedies should be on the way. For the time being though, perhaps it would be a good idea to start making morning appointments when it’s time for you to visit the doctor.
References:
Gordon M. 2020. Good medical care can suffer late in the day [Internet]. National Public Radio; [cited 2020 March 9]. Avaialble from https://www.npr.org/sections/health-shots/2020/02/29/804929853/good-medical-care-can-suffer- late-in-the-day
Linder JA, Doctor JN, Friedberg MW. 2014. Time of day and the decision to prescribe antibiotics. JAMA [Internet]. [cited 9 March 2020]; 174(12):2029-2031. Available from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1910546?utm_campaign=arti clePDF%26utm_medium%3darticlePDFlink%26utm_source%3darticlePDF%26utm_content%3 djamanetworkopen.2019.10373
Neprash HT, Barnett ML. 2019. Association of primary care clinic appointment time with opioid prescribing. JAMA [Internet]. [cited 9 March 2020];2(8):e1910373. Available from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749268?utm_campaign=articleP
DF%26utm_medium%3darticlePDFlink%26utm_source%3darticlePDF%26utm_content%3djam anetworkopen.2019.10373
Hsiang EY, Mehta SJ, Small DS, Rareshide CAL, Snider CK, Day SC, Patel MS. 2019. Association of primary care clinic appointment time with clinical ordering and patient completion of breast and colorectal cancer screening. JAMA [Internet]. [cited 9 March 2020];2(5)e193403. Available from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733171?utm_campaign=articleP DF%26utm_medium%3darticlePDFlink%26utm_source%3darticlePDF%26utm_content%3djam anetworkopen.2019.3403
Cover Image: Rawpixel. 2017. File: Doctors Items.jpg [Internet]. Wikimedia Commons; [cited 2020 March 9]. Available from https://commons.wikimedia.org/wiki/File:Doctors_Items.jpg
scheduling it so it doesn’t interfere with your work, school, and other plans. You likely don’t worry about whether your appointment time will affect the medical care you receive, but maybe you should.
Recent research has shown that as the work day goes on, and as appointments fall further and further behind, the quality of care patients receive from their doctor goes down. One study found that physicians were more likely to prescribe antibiotics to patients seen later in the day (Linder et al. 2014). Another found that opioid prescriptions also increased with later appointments. In fact, the researchers stated that if opioid prescriptions had been consistent from the first appointment of the day, there would have been almost 4500 fewer opioid prescriptions ordered in 2017 alone (Neprash and Barnett 2019). While easy fix prescriptions increased over the course of the day, preventative care measures decreased, like flu vaccinations and orders for mammograms.
It is suspected that these trends are seen because doctors are weary later in the day. These preventative measures or pain treatments, which are not easy fixes to patients’ problems, require time for the doctor and patient to sit down and have a conversation (Gordon 2020). This can also explain why the trends correlate with appointments running behind schedule. Having to explain to a patient in pain how physical therapy may be a good option for them though the results are not immediate, can seem like it will not fit into a doctor’s chaotic schedule. Instead they acknowledge the patient’s pain and prescribe opioid painkillers, showing the patient that they take their symptoms seriously.
Another proposed reason for deteriorating care throughout the day is decision fatigue. Decision fatigue is the declining of self-control as you continue to make decisions throughout the day. Medicine isn’t the only field that may be facing the harm of decision fatigue. Data has shown that as the day goes on, judges are less likely to grant parole. Choosing to grant parole requires more thought about the intricacies of the case than just deciding to deny it (Linder et al. 2014). After already having seen a multitude of patients all with different ailments and symptoms, it is certainly plausible that a doctor’s ability to make informed, complex decisions will be diminished, causing them to just pick the easy way to alleviate a patient’s symptoms.
There is also the argument that a patient’s own decision fatigue could be contributing to this issue. Patients are coming into doctors’ offices for their appointment after having spent their own days having to make decisions at work, at home, while running errands, etc. When their doctor comes in and tells them that they are due for a cancer screening or that flu season is beginning, the idea of having to schedule an uncomfortable procedure or get stuck by a needle may just seem exhausting (Gordon 2020). Instead, they tell the doctor they would rather wait and discuss it during their next appointment.
The studies that found these trends in medical care have proposed some solutions to the end of the day weariness, time crunch, and decision fatigue that may be contributing to a deterioration in patient care. One such proposal is that medical assistants, in lieu of doctors, could be put in charge of discussing and ordering screening tests for patients, which the doctor will then approve. These tasks do not require the doctor to be present, so it would allow them to spend their time with patients focusing more on the nuanced care of injury and illness (Gordon 2020). There are some other easy modifications that could be made to a doctor’s schedule to help
reduce the strain they feel later in the day, like adding mandatory breaks and pausing to have snacks (Linder et al. 2014). The next step is to put these adjustments to the test to see if they have their desired effect.
While these results may seem a bit scary as a patient, the fact that this research is being done is a good sign that the problems are being acknowledged and that remedies should be on the way. For the time being though, perhaps it would be a good idea to start making morning appointments when it’s time for you to visit the doctor.
References:
Gordon M. 2020. Good medical care can suffer late in the day [Internet]. National Public Radio; [cited 2020 March 9]. Avaialble from https://www.npr.org/sections/health-shots/2020/02/29/804929853/good-medical-care-can-suffer- late-in-the-day
Linder JA, Doctor JN, Friedberg MW. 2014. Time of day and the decision to prescribe antibiotics. JAMA [Internet]. [cited 9 March 2020]; 174(12):2029-2031. Available from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1910546?utm_campaign=arti clePDF%26utm_medium%3darticlePDFlink%26utm_source%3darticlePDF%26utm_content%3 djamanetworkopen.2019.10373
Neprash HT, Barnett ML. 2019. Association of primary care clinic appointment time with opioid prescribing. JAMA [Internet]. [cited 9 March 2020];2(8):e1910373. Available from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749268?utm_campaign=articleP
DF%26utm_medium%3darticlePDFlink%26utm_source%3darticlePDF%26utm_content%3djam anetworkopen.2019.10373
Hsiang EY, Mehta SJ, Small DS, Rareshide CAL, Snider CK, Day SC, Patel MS. 2019. Association of primary care clinic appointment time with clinical ordering and patient completion of breast and colorectal cancer screening. JAMA [Internet]. [cited 9 March 2020];2(5)e193403. Available from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733171?utm_campaign=articleP DF%26utm_medium%3darticlePDFlink%26utm_source%3darticlePDF%26utm_content%3djam anetworkopen.2019.3403
Cover Image: Rawpixel. 2017. File: Doctors Items.jpg [Internet]. Wikimedia Commons; [cited 2020 March 9]. Available from https://commons.wikimedia.org/wiki/File:Doctors_Items.jpg
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