Decision Fatigue Contributes to Prescribing Practices

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Decision Fatigue Contributes to Prescribing Practices

New research published in JAMA Internal Medicine points to fatigue on the part of prescribers affecting the number of antibiotic prescriptions written, which may be contributing to the rise in antibiotic resistance.

The study’s co-author, Jeffrey A. Linder, MD, of the Division of General Medicine and Primary Care, Brigham and Women’s Hospital in Boston, reported that in their review of 21,867 respiratory infection visits to primary care clinics, physicians were 26 percent more likely to prescribe an antibiotic in the fourth hour of a shift compared to the first hour. Linder went on to say that their antibiotic prescribing is inconsistent with the diagnosis they’re giving the patient.

Past studies have examined people’s tendencies to opt for the easiest or safest choices when they’ve been making a lot of decisions and may be feeling burned out. This pattern is also evident among judges who are more likely to deny parole later in the day.

This same decision fatigue may affect other prescribing habits as well, such as opioids for complaints of pain. Physicians may wish to avoid a protracted discussion with a patient by simply writing the requested prescription even though they may have misgivings about its suitability.