''DOCTOR'S NOON FATIGUE'' : [2]

EVERYONE suffers decision fatigue, even physicians.

In a 2014 study, my fellow researchers and I found doctors prescribed fewer unnecessary antibiotic prescriptions for respiratory infections first thing in the morning, but that unnecessary prescriptions gradually increased over the day.

We found the exact same doctor, caring for the exact same patient had a 26 percent higher chance of writing an antibiotic prescription at 4 p.m. compared to 8 a.m.

As doctors got more fatigued, they defaulted to the easy thing : just writing an antibiotic prescription rather taking the time to explain to patients why it is not necessary.

As they went on, doctor's fears of disappointed, dissatisfied, angry or confrontational patients may have loomed larger and larger. They will to confront these fears may have dwindled and more patients left-the-clinic with unnecessary antibiotics.

The same pattern of doctors defaulting to the easy thing later in the day has appeared for decreased influenza vaccinations, increased opioid prescribing for back pain and decreased physician hand-washing.

We doctors like to think of ourselves - and the public might like to think of us - as rationale decision makers, but depending on the time of the day, treatments change.

What can be done?

Half the battle is knowing this exists, finding a plan to compensate and maybe taking a quick break.

But scheduling mandatory breaks doesn't cut down the amount of work. Certainly, improving the efficiency of the current generation of electronic health records would help things go more smoothly in the office.

Most cancer screening and preventive services could be done outside of face-to-face visits by support staff. This would allow doctors to focus on necessary care in the moment.

But that requires big changes to most health insurance, which still largely pays only for in-person visits.

The honor and serving of the latest operational research on Medicine, Doctors, and Practices, continues.