Health Column: What time of day will you get better health care?
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
Going to see your physician? Asking for the first appointment in the morning has been my long standing advice to family and friends. Why? Most docs start their office hours on time, but rather quickly, get behind. It is certainly the rule in primary care where even the World’s Best Scheduler (Deb Stegall) can’t always take into account the extra question about hemorrhoids or the teenage daughter acting out. The earlier in the day you get your appointment, the less time you will spend cooling your heels in the reception area (formerly called the “waiting room”).
Now there is another reason to see your health care provider earlier, rather than later in the day. A group of physicians at Brigham and Women’s Hospital in Boston analyzed the electronic health records of 21,000 clinic visits of adults diagnosed with an acute respiratory illness. They found that the likelihood that a patient would be prescribed antibiotics increased throughout both the morning and afternoon office visit sessions. By the end of each four-hour session, five-percent more patients received antibiotics than at the beginning of the session.
The authors suggest that the physicians were suffering from “decision fatigue,” a phenomenon that has been described in airline pilots and judges. When docs are physically tired or squeezed by another commitment (a noon meeting or need to pick up the kids at five), their priorities may change as the end of the day approaches. And the quality of care may suffer. Taking the extra time to explain to a patient why antibiotics are not appropriate may be trumped by the quicker alternative of writing a prescription.
My Take: Be careful not to over-read the findings. This is not to suggest that medical care delivered after 10 a.m. is faulty. It is a reminder that physicians are subject to the same time demands and fatigue issues as everyone else.
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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