Doctors’ clinical judgement worsens as the day progresses due to ‘decision fatigue’, a US study has found.
To investigate how the time of day influences medical decision making, researchers looked at the rates of ordering of guideline-recommended cancer screening tests by physicians in 33 primary care practices.
They found that clinicians’ ordering rates of breast cancer screening tests was highest at 8 am ( 64%), decreased throughout the morning to 49% at 11 am, increased slightly to 56% at noon, and then decreased to 47.8% at 5 pm. A similar decline in test ordering patterns was seen for colorectal cancer screening, decreasing from 36.5% at 8 am to 31.3% by 11 am, increasing at noon to 34.4%, and then decreasing to 23.4% at 5pm.
The trend for decreasing test ordering as the day progressed was statistically significant, said researchers from Johns Hopkins University School of Medicine.
While some of the decline could be due to physicians falling behind schedule and having more rushed appointments, there was also likely also an element of ‘decision fatigue’, they wrote in JAMA Network Open.
The researchers defined decision fatigue as “the depletion of self-control and active initiative that results from the cumulative burden of decision making”.
“In other words, as the day goes on, clinicians may be less likely to discuss cancer screening with patients simply because they have already done this (and made other decisions) a number of times”.
“As patients earlier in the day decline screening despite the clinician’s recommendation, it could influence how likely the clinician is to bring up the topic later in the day with a different patient.”