
Doctors and decision fatigue - hhs
https://www.nytimes.com/2019/05/14/opinion/dont-visit-your-doctor-in-the-afternoon.html
======
jonas21
The author uses the Israeli parole board study as an example supporting his
case, but doesn't mention that the study failed to account for other factors
that might affect parole decisions.

When other researchers took a closer look, it turned out that in each session,
prisoners without attorneys (who are less likely to be granted parole) were
scheduled last, just before the breaks. After accounting for this and several
smaller factors, the original conclusion could no longer be supported. [1]

[1]
[https://www.pnas.org/content/108/42/E833.full](https://www.pnas.org/content/108/42/E833.full)

~~~
windexh8er
I'm about halfway through "When, The Scientific Secrets of Perfect Timing" and
it references many studies and topics relating to, obviously, timing. Many
hospitals have implemented mandatory break schedules to combat this. An
interesting read so far, recommended if you enjoy the linked article from the
HN post.

[https://www.goodreads.com/book/show/35412097-when](https://www.goodreads.com/book/show/35412097-when)

And direct from the author some insights from the book:

'Afternoons are the Bermuda Triangles of our days. Across many domains, the
trough represents a danger zone for productivity, ethics, and health.
Anesthesia is one example. Researchers at Duke Medical Center reviewed about
90,000 surgeries at the hospital and identified what they called “anesthetic
adverse events”— either mistakes anesthesiologists made, harm they caused to
patients, or both. Adverse events were significantly “more frequent for cases
starting during the 3 p.m. and 4 p.m. hours.” The probability of a problem at
9 a.m. was about 1 percent. At 4 p.m., 4.2 percent. In other words, the chance
of something going awry was four times greater during the trough than during
the peak. On actual harm (not only a slip up but also something that hurts the
patient), the probability at 8 a.m. was 0.3 percent — three-tenths of one
percent. But at 3 p.m., the probability was 1 percent — one in every one
hundred cases, a threefold increase. Afternoon circadian lows, the researchers
concluded, impair physician vigilance and “affect human performance of complex
tasks such as those required in anesthesia care.”'

[https://www.linkedin.com/pulse/youre-more-likely-screw-up-
af...](https://www.linkedin.com/pulse/youre-more-likely-screw-up-afternoon-
heres-how-stop-daniel-pink)

~~~
kazagistar
The next step though would be individuation of results. Are these consistent,
or is there some minority that has the opposite results?

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blt
If you want the attention of a crowd, speak at 10am.

Any earlier, the night people won't be well-rested.

11am, the morning people become hungry for lunch and impatient.

After lunch, anyone who overate will be sleepy.

By the time everyone's digested their lunch, the older morning people are
fading for the day.

10-11am is the golden hour.

~~~
newsbinator
This is surprisingly poorly understood by everyone from consultants and sales
people to speaking coaches.

It doesn't matter what you say or how you say it (within reason) if you're
battling against your audience's metabolism the whole time.

~~~
scruple
My favorite is half-day or all-day meetings where they always plan out 10
minutes for a break every hour and it just slips and slips. You end up being
lucky if you can get 10 minutes of an "official" break in a 4 hour window.

I've taken to just getting up and walking away for my 10 minutes. I have to
piss. I need a coffee, or some water, or just the opportunity to go and breath
some other stale air in some other corner of the office (I work full-time
remote, so it's generally my own stale air, but the point remains). How is
this lost on so many people? It strikes me as being so basic and so obvious
and I feel like I invariably end up looking like an asshole because I can't
sit in a chair and listen to people fill a volume of space with their words
for 2 hours straight.

~~~
B1FF_PSUVM
> people fill a volume of space with their words for 2 hours straight.

And those are the run of the mill self-lovers. Real pros like Fidel Castro and
others of the ilk could go solo for up to 7 hours.

(The other day heard from someone who attended one of those speeches. Not a
happy memory, for some reason.)

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apawloski
My colleague recently recommended the book "Why We Sleep" by Matthew Walker.
While I was expecting it to tout the benefits of good sleep, I was surprised
at the evidence around the inverse: __not __getting a full night 's sleep is
alarmingly bad for you.

The evidence suggests that this extends far beyond cognitive and psychological
health impacts. For example, the author notes that there is a 24% increase in
heart attacks the day after we lose an hour of sleep during daylight savings.
This is just the tip of the iceberg, in my opinion.

Given these mental and physical risks, it is insane that we allow physicians
to routinely work shifts that endanger themselves and lead to measurable drops
in their performance.

~~~
bigred100
I believe we need to do away with “the Kaiser’s trick hour” and restore a
truly reliable, truly American sense of time

~~~
mattsouth
There's talk of doing away with it in Europe: [https://www.theguardian.com/uk-
news/2019/mar/26/when-do-the-...](https://www.theguardian.com/uk-
news/2019/mar/26/when-do-the-clocks-go-forward-change-2019-daylight-savings-
time)

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jhayward
I've long advised my family and friends: "always take the 1st appointment or
flight of the day. Never book the end of the day's schedule" for doctors
visits and airline flights. Chaos, delay, and error compound themselves
throughout the day and then get reset to baseline overnight.

~~~
draugadrotten
That, or after a break or meal is the best to meet the judge.

"They found that the likelihood of a favourable ruling peaked at the beginning
of the day, steadily declining over time from a probability of about 65% to
nearly zero, before spiking back up to about 65% after a break for a meal or
snack."

[https://www.theguardian.com/law/2011/apr/11/judges-
lenient-b...](https://www.theguardian.com/law/2011/apr/11/judges-lenient-
break)

~~~
dredmorbius
Debunked.
[https://news.ycombinator.com/item?id=19915540](https://news.ycombinator.com/item?id=19915540)

------
adolph
Maybe doctors should work less?

 _Hospitalization with acute myocardial infarction during Transcatheter
Cardiovascular Therapeutics meeting dates was associated with lower 30‐day
mortality, predominantly among patients with non–ST‐segment–elevation
myocardial infarction who were medically managed._

[https://www.ahajournals.org/doi/10.1161/JAHA.117.008230](https://www.ahajournals.org/doi/10.1161/JAHA.117.008230)

~~~
code_duck
For some reason, society has this observational attitude about these
practices. It’s not clear to me at all while medical institutions think
doctors and nurses need to work excessive amounts of hours in a row with no
rest.

~~~
retiredcoder
I guess real doctors can be more precise than me here.

However, at where I live only doctors working with trauma/ER work long hours.
From what I understand, that’s mostly to work around the overhead of context
switch and patient hand over. For my friend, a lot of stress came from the
responsibility, which might not be well distributed across specializations
(hence the insurance premiums, etc).

~~~
code_duck
It just doesn’t seem to me that having a doctor who has been awake for 22
hours straight is preferable to handing the patient over to a doctor who has
slept within the last day.

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WheelsAtLarge
I'm one that likes(liked) to schedule doctors appointments in the afternoon.
My experience has been a bit negative. I've had doctors that rush because they
are running late, inattentive because they are tired, cancel because they have
other appointments, doctors that seem to want to discuss their previous cases,
and they have plainly told me that they can only give me a few minutes because
they have other things to do. I suspect that even the ones that are attentive
are thinking about other things than my situation.

It turns out that doctors are people too. So I completely agree an AM
appointment is your best bet if you want to get the best service from the
doctor.

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GavinMcG
Related quasi-counterpoint: [http://m.nautil.us/blog/impossibly-hungry-
judges](http://m.nautil.us/blog/impossibly-hungry-judges)

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RcouF1uZ4gsC
From the reference JAMA study: As the clinic day progresses, clinicians may
fall behind schedule and experience decision fatigue

I wish the paper tried to differentiate which of these two it was. My guess is
that it would have more to do with falling behind schedule than decision
fatigue. When you are already behind schedule, you at least subconsciously try
to do stuff that minimizes your time. Having a long talk about required
screening or arguing about antibiotics may not feel very worthwhile to you
when you have 6 patients that have been waiting an hour for you.

~~~
criddell
I always try to get the first appointment of the day. The thing that annoys me
to no end is that doctors are already running late by that time. Sometimes I
think there's a basic lack of respect for their patient's time.

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bitL
Imagine having the purest ideals of helping people when entering medical
profession, only to end up burned out, going through motions, knowingly but
hopelessly harming your own patients, leading you to substance abuse to cope
with that as the system is set up to drive you to the brink of collapse. I am
wondering what kind of sociopaths designed medical profession guidelines,
maximizing unintended damage, depriving doctors of any quality off-time for
their own recovery.

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netwanderer3
For those who need to take a driving test, it's always best to try schedule it
for the earliest morning time slot. The examiners typically don't want to
start off their day by being a prick and fail someone.

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agumonkey
I think we need a push up toward a simpler and slightly denser monitoring
culture across the whole board. Just enough so everybody can keep the rate but
decrease the errors.

