Time of Day Affects When a Doctor May Prescribe Certain Medications

Doctors—they’re just like us.

Although we’d all like to think that our doctors are superhuman, when it comes to end-of-day fatigue, it turns out that your physician gets tired, too. According to a new study by researchers at Brigham and Women’s Hospital, doctors may make “inappropriate choices” later in the day, especially in primary care, where doctors often prescribe unnecessary antibiotics for acute respiratory infections.

The researchers found that the doctors appear to “wear down” during morning and afternoon patient visits, and therefore, antibiotic prescribing rates increased throughout the day. These findings were published October 6 in JAMA Internal Medicine. 

“Clinic is very demanding and doctors get worn down over the course of their clinic sessions,” explained Jeffrey A. Linder, MD, a BWH physician and lead author of the study, in a statement. “In our study we accounted for patients, the diagnosis, and even the individual doctor, but still found that doctors were more likely to prescribe antibiotics later in their clinic session.”

According to the study:

The researchers looked at the billing and electronic health record (EHR) data for patient visits to 23 different primary care practices over the course of 17 months. Then identified visit diagnoses using billing codes and, using EHRs, identified visit times, antibiotic prescriptions and chronic illnesses. They analyzed over 21-thousand ARI visits by adults, which occurred during two four-hour sessions, 8 a.m. to noon and 1 p.m. to 5 p.m. The researchers found that antibiotic prescribing increased throughout the morning and afternoon clinic sessions.

“This corresponds to about 5 percent more patients receiving antibiotics at the end of a clinic session compared to the beginning,” Linder said in a statement. “Remedies for this problem might include different schedules, shorter sessions, more breaks, or maybe even snacks.”