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Doctors are more likely to prescribe unnecessary antibiotics in the afternoon


Health-care providers are more likely to erroneously prescribe antibiotics later in the day, according to a new study. And it's probably because their minds get tired as the day goes on.

This is called "decision fatigue" — a person's mental energy erodes as he or she is confronted with more and more decisions over the course of the day. And this phenomenon shows up in other areas, as well. For example, one study found that judges were less likely to approve parole for prisoners as the day wore on (presumably because that was the easier and safer choice).

Overprescribing antibiotics isn't just a waste of money. It's a major cause of one of the most dire health-care problems facing the world — antibiotic-resistant infections.

Antibiotic-resistant infections are currently killing 23,000 Americans each year because bacteria are evolving to outsmart our drugs. This problem has been exacerbated by overuse of antibiotic drugs in both medicine and in livestock. Every time an antibiotic drug is used, bacteria get another chance to evolve defenses against it. (Meanwhile, drug companies aren't making as many new antibiotics as they used to.)

In this newest study, published online in JAMA Internal Medicine on October 6, a team of researchers examined the billing and electronic health records for 21,867 visits for acute respiratory infection.

Of the patients who should not have received antibiotics, one third did anyway. (Some of the patients, for example, had viral infections — and antibiotics only kill bacteria, not viruses.)

And there was a clear trend over time. As the day went on, doctors and nurses were more likely to prescribe antibiotics, even when they shouldn't have (the squares below are when they should not have been prescribing these drugs):

Antibiotics prescribing time of day
(Linder, JA et al. JAMA Internal Medicine. October 6, 2014)

The authors pointed out that glucose fatigue (basically, not enough sugar in the body) or general fatigue could also be happening here. And they suggested some possible fixes. "Remedies for decision fatigue might include time-dependent decision support, modified schedules, shorter sessions, mandatory breaks, or snacks," they write.

Yes, snacks. Being hungry doesn't just make people hangry (a real anger phenomenon shown in this other study). It also seems to make people's brains lazier when making decisions.

Further reading: John Tierney wrote a great, in-depth look at the science of decision fatigue, including its implications for dieting and self-control, for The New York Times.

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