Antibiotics Prescribed More Often in Afternoon Clinics

According to a recent study, doctors are much more likely to wrongly prescribe antibiotics later in the day due to tiredness. The study found that family doctors become “worn down” by having to make a series of decisions through the day, and that by late afternoon they were far more likely to dish out antibiotics for respiratory infections than during morning appointments.

Researchers adjusted the study to make allowances for different types of patients, the end diagnosis and even the individual doctor, but it was still shown that doctors were more likely to give antibiotics as the day progressed.

These findings were published in JAMA Internal Medicine [ the peer-reviewed medical journal published twice a month by the American Medical Association]. The study was done by looking at 21,000 visits by adults to their GP surgery during morning (8am to 12 noon) and afternoon (1pm to 5pm) sessions. The study looked at data from 23 different primary care practices over almost a year and a half.

Doctors are continuing to prescribe more and more antibiotics despite worries that over-prescribing is fuelling the growth of superbugs which could prove dangerous in the future for patients undergoing routine medical treatments and procedures. In some areas of the UK, doctors are prescribing twice as many antibiotics than those in other areas.

Many GPs have confessed to giving patients antibiotics to “get rid of them” or to deal with over-anxious parents. The UK government has set up a taskforce to look at the growing resistance to antibiotics and might investigate each practice’s prescribing rates.

The research seems to prove that GPs get “worn down” during their working day, and by afternoon, antibiotic prescribing was on the rise. The data showed that around 5% more patients were getting antibiotics at the end of a clinic compared with earlier and researchers also suggest a number of ways around this, such as looking at clinic schedules, making sessions shorter and giving doctors more breaks or snacks.

Doctors – just like Israeli Judges!

We’re not surprised by these findings as we’ve blogged on something very similar before. Back in 2011 I posted an article on the business log of our main law firm website which was called “Do Judges eat often enough?” That article was based on research carried out by a prestigious Israeli University and was published in Proceedings of the National Academy of Sciences.

The Israeli researchers discovered that the meal time habits of Israel’s judges affected whether or not they approved parole applications. The research showed that at the start of the working day, around 2 out of 3 applications for parole was granted. As the day wore on, the judges began to refuse more and more applications, and the approval rate finally dropped to zero. After a break for a meal however, approval rates went right back up to almost the original level, and then started to fall once more.

The accepted explanation for this is blood sugar levels dropping through the day. The theory goes on to state that making decisions is taxing, and as people start to get tired, they look for the easiest solution. In the case of the judges, refusing to grant parole is easier than accepting. There is evidence to back this theory too; favourable judge decisions to grant parole took 7.4 minutes on average, whereas decisions to refuse only took 5.2 minutes. Longer written verdicts were also issued in favourable decisions at 90 words on average compared with 47 words when rejecting.

It’s therefore hardly surprising that prescribing errors in American doctors mirror the experiences of parole hearings and the eating times of judges in Israel.

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