Choose Wisely As To When You Schedule Your Medical Care

Choose Wisely As To When You Schedule Your Medical Care Posted By:
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Most of us tend to need a pick-me-up—perhaps a cup of coffee—around mid- to late-afternoon. But a new study published by JAMA on May 10, 2019 in Network Open appears to reveal that physicians are less likely to order routine cancer screening tests at the end of their workdays.

This study of 33 primary care practices in the University of Pennsylvania Health System examined the rate at which routine colon and breast cancer screenings were ordered. The study revealed that rates of screening in 33,468 patients eligible for colorectal cancer screenings and 19,254 patients eligible for breast mammograms was highest early in the workday and generally fell throughout the day, with some upward fluctuations near lunchtime. In each instance, US Preventive Services Task Force guidelines were utilized, and in the case of colorectal cancer these screenings included not only colonoscopy but sigmoidoscopy and non-invasive tests—including fecal immunochemical test, fecal occult blood test, and stool DNA test.

Colorectal cancer screenings were recommended a dismal 36.5% of the time at 8:00 AM but dipped to a shockingly low 23.4% at 5:00 PM. And these are screenings ordered, not completed, which were far lower. Mammography fared slightly better, starting at 63.7% of the time at 8:00 AM and dipping to 47.8% at 5:00 PM.

Called decision fatigue in the retail sales world, for years businesses have utilized our weariness late in a purchase negotiation or just late in the day to promote unnecessary or expensive purchase add-ons, such as sugary, unhealthy foods at the checkout counter. Previously, medical studies had identified a decline in vaccine recommendations and a greater number of unnecessary antibiotic and opioid prescriptions later in the day.

Can anything be done about this? Work studies reveal that this involves something called the nudge unit. This involves small changes in the choices or options presented to employees: generic medicines being the first choice in a drop-down menu when a brand name is entered, or a protocol recommending a vaccination when appropriate. Unfortunately, this adds mouse-clicks to an electronic health record. The other choice is economic: changing reimbursement to reward for better decision-making recommendations, or penalizing for failure to recommend.

Personally, I'd opt for an extra mouse-click. And I like the help of a reminder when I really need a venti latte.

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Filed under: Health Policy and Trends

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