Well: Doctors and Decision Fatigue

Written By Unknown on Rabu, 29 Oktober 2014 | 13.57

The phenomenon of "decision fatigue" has been found in judges, who are more likely to deny parole 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 in JAMA Internal Medicine, scientists analyzed diagnoses of acute respiratory infections in 21,867 cases over 18 months in primary care practices 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. Over all, compared to the first hour, the probability of a prescription for antibiotics increased by 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."

Correction: October 29, 2014
A report in the In Brief column on Tuesday about a study that has found that the phenomenon of "decision fatigue" exists in doctors, causing them to prescribe more antibiotics at the end of their shifts than at the beginning, referred incorrectly to the phenomenon in judges. Studies have shown that judges are more likely to deny parole — not bail — at the end of the day than at the beginning.

A version of this article appears in print on 10/28/2014, on page D4 of the NewYork edition with the headline: Nostrums: Prescribing More While Tired.


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