The phenomenon of "decision fatigue" has been found in judges, who are more likely to deny bail at the end of the day than at the beginning.
Now researchers have found a parallel effect in physicians: As the day wears on, doctors become increasingly more likely to prescribe antibiotics even when they are not indicated.
For the study, published as a research letter in the December issue of JAMA Internal Medicine, scientists analyzed diagnoses of acute respiratory infections in 21,867 cases to 204 doctors over 18 months in 23 primary care practices that use electronic health records and billing systems in and near Boston.
In two-thirds of the cases, antibiotics were prescribed even though they were not indicated. But whether they were indicated or not, the number of prescriptions increased with time. Overall, compared with the first hour, the probability of a prescription for antibiotics increased 1 percent in the second hour, 14 percent in the third hour and 26 percent in the fourth.
"The radical notion here is that doctors are people, too," said the lead author, Dr. Jeffrey A. Linder, an associate physician at Brigham and Women's Hospital in Boston, "and we may be fatigued and make worse decisions toward the end of our clinic sessions."
But, he added, the patient can help. "If you want the best care, you should say that you are there to be evaluated and only want an antibiotic if it's really needed," he said.
Unnecessary use of antibiotics encourages the growth of antibiotic-resistant bacteria. When a person takes an antiobiotic, many kinds of microbes in the body are exposed to the medication -- not merely whatever agent might be causing a current illness. According to information posted by the federal Centers for Disease Control and Prevention, "when bacteria are exposed to antibiotics, they start learning how to outsmart the drugs. ... Each time bacteria learn to outsmart an antibiotic, treatment options are more limited, and these infections pose a greater risk to human health."
Celia Storey added information to this report.
ActiveStyle on 12/15/2014