Health

Here’s the Best Time to See the Doctor

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Cancer screening was ordered more often for patients with morning appointment. Getty Images

Does the time of your doctor’s visit affect the quality of your care?

Definitely.

In a recent study published in JAMA Network Open, researchers looked at the effect that time of day had on cancer screening orders using data from a group of more than 50,000 patients eligible for either colorectal cancer screening or breast cancer screening.

They found that as the hours of the day progressed, doctors were less likely to order these tests.

“What we found was that if you saw your doctor earlier in the morning, particularly at the beginning of a shift, the morning and afternoon shifts, that you were more likely to get cancer screening ordered than if you saw your doctor later in the day,” said Dr. Mitesh Patel, assistant professor of medicine and health care management at the University of Pennsylvania Perelman School of Medicine, staff physician at the Cpl. Michael J. Crescenz Veterans Affairs Medical Center in Philadelphia, and co-author of the study.

But the burden isn’t solely on doctors, either. Patients were followed for a year after and researchers found a similar pattern in completion rates for cancer screening.

Those who saw their doctors earlier in the day were more likely to have completed their cancer screening one year later than if they saw them in the afternoon.

Going to the doctor at 8 a.m. was associated with the highest rate for ordered screening tests at 64 percent. The percentage decreased throughout the course of the morning to 49 percent by 11 a.m.

Those numbers received a bump at noon up to 56 percent, which Patel attributes to the start of a new shift, before hitting their lowest, 48 percent, in the afternoon.

Well, first, these kinds of trends aren’t limited to cancer screening. Similar studies, some of them authored by Patel himself, have noted the same patterns of lapses in care emerging in everything from flu vaccination rates to unnecessary antibiotic prescriptions, and even hand-washing in hospitals.

The later in the day you see your doctor, the more likely quality of care may suffer.

“I think it’s not just a matter of not bringing things up, but also a matter of making worse decisions, that we are doing more of the things we shouldn’t be doing as well and not doing the things we should,” said Patel.

The phrase that is brought up most frequently to explain this phenomenon is “decision fatigue,” or the simple premise that making lots of decisions during the day can wear you down.

Decision fatigue is a likely culprit for poor decision making. And it’s not just limited to doctors.

Can’t resist a candy bar as you check out of the grocery store after a long day? Chalk it up to decision fatigue.

“It certainly seems that decision fatigue is affecting patients seen later in the day,” said Dr. Barbara Keber, chair of family medicine at Northwell Health’s Glen Cove Hospital in Glen Cove, New York.

Keber wasn’t involved in the study.

But for doctors, the stakes of each individual decision made during the day can be much higher — literal life or death decisions in some cases.

Decision fatigue can be compounded by other factors like scheduling issues and rushed visits, which can force a doctor to spend less time with a patient and make more decisions.

Again, those issues are similarly true for patients. At the end of the day, a patient may need to get home to make dinner or pick up a child from school and just not have the time or mental capacity to talk about something as complex as cancer screening.

Patel admits that right now the data indicates that patients who see their doctors earlier in the day are more likely to get recommended screenings, but he doesn’t recommend immediately rescheduling your doctor’s visit.

“I’m not advising that people change their appointments to the morning. I think what I am saying is that if people are aware of this issue then you can actually help to prevent this,” he said.

For patients, that means being informed about your visit and making the best possible use of it.

When you see your doctor, be prepared and know what is important to you, whether that means cancer screening or an immunization booster.

And don’t be afraid to prompt serious conversations yourself.

Cancer isn’t easy to talk about — for anyone — but if you’re due for a screening, take the opportunity to address it with your healthcare provider.

“The key takeaway is really to understand that if you’re prepared and you allocate enough time, then it shouldn’t matter what time of the day you see your doctor,” said Patel.

In a recent study, researchers looked at the effect that time of day had on cancer screening orders using data from a group of more than 50,000 patients eligible for either colorectal cancer screening or breast cancer screening.

They found that as the hours of the day progressed doctors were less likely to order these tests.

Patients who saw their doctors earlier in the day were more likely to have completed their cancer screening one year later than if they saw them in the afternoon.


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