There are many reasons why the world is experiencing a crisis of antibiotic resistance. Now a paper published in JAMA Internal Medicine reveals a new one: tired doctors.
The use of antibiotics on farm animals and people failing to complete prescriptions are a big part of the reason that many antibiotics no longer provide us with the protection they once did. However, the practice of prescribing antibiotics for viral conditions, while decreasing, remains a major issue.
So why do doctors, who one would hope are aware of the dangers of undermining one of the greatest medical advances in history, keep giving patients antibiotics they don’t need? Many doctors report being asked for pills by patients who appear to have viruses, some of whom don't take no for an answer. "Clinic is very demanding and doctors get worn down over the course of their clinic sessions," explained lead author Dr. Jeffrey Linder of Bringham and Women’s Hospital, Boston.
Linder and his co-authors note that doctors are not the only ones affected, pointing to research showing, “As court sessions wear on, judges are more likely to deny parole, the 'easier' or 'safer' option.”
By combining billing data with electronic health records for 23 primary care practices, Linder and his colleagues were able to look at 21,000 adult visits. They found that as the 8am-midday and 1pm-5pm sessions wore on, doctors started giving out more antibiotic prescriptions. The study was controlled by symptoms to ensure people with bacterial infections were not showing up later in the day.
"This corresponds to about 5% more patients receiving antibiotics at the end of a clinic session compared to the beginning," Linder said. While this difference may seem small, the percentage is an average and some doctors may be much more affected.
A previous study, in which Linder was also involved, found that something as simple as displaying a poster indicating a commitment to not over-prescribe antibiotics in examination rooms could reduce unnecessary prescriptions by almost 20%.
Linder suggested, "Remedies for this problem might include different schedules, shorter sessions, more breaks or maybe even snacks." Moreover, by demonstrating that factors such as fatigue can make a difference, the study may indicate further factors that could be even larger contributors to doctors failing to act responsibly.
So it seems that if you want antibiotics, make an appointment just before lunch or late in the afternoon. On the other hand, if you actually want the best treatment, it might be best to get in early.