According to a new report, patients who saw their physicians earlier in the day were more likely to receive necessary health screenings.

By Alexandra Lim-Chua Wee
May 13, 2019
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When it comes to seeing your doctor about a health concern, "the sooner, the better" is likely already your rule of thumb; however, according to a new report, going earlier in the day may be better for you, too.

The report, which was published in JAMA and led by researchers at the Penn Medicine Nudge Unit, looked at primary care doctors and the rate at which they ordered cancer screenings over the course of a day. Researchers specifically looked at patients eligible for breast or colon cancer screenings, and followed up with these patients a year later to see who completed their tests and whether the time at which they visited their doctors played a role.

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The findings? Patients who came earlier in the day were more likely to receive a cancer screening test. Nearly 64 percent of women eligible for breast cancer screenings who came in at 8 a.m. received mammogram orders while that number fell to 48% by 5 p.m. Similarly, for patients who were eligible for colon cancer screenings, 37 percent of them received orders for a colonoscopy at 8 a.m. while only 23 percent did by 5 p.m. When following up with patients a year later, researchers also found that those who saw their doctors later in the day were less likely to have completed their screenings. Previous studies by the report's researchers found similar patterns in patients getting flu vaccinations. Patients visiting their primary care providers later in the day were also more likely to receive unnecessary antibiotic prescriptions.

As for the reason behind all of this, researchers name the phenomenon "decision fatigue." "It's the tendency to make poorer choices following a long stretch of making a lot of other decisions," writes Mitesh Patel, director of the Penn Medicine Nudge Unit, staff physician, and one of the report's authors, in an article for STAT. "Grocery stores take advantage of this by placing candy near the checkout line. After making many decisions about which foods to purchase, consumers may make less healthy choices toward the end of their shopping." Patel and his team found that this phenomenon affected both doctors and patients.

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The schedules of doctors-and the domino effect that one or two delays earlier in the day can have on the rest of the day's appointments-can also be to blame, notes Patel, as this can lead to doctors rushing through their later appointments. Similarly, researchers say patients may also be rushing to get home at the end of the day and are therefore less receptive to making decisions about getting screenings.

As for how these concerns should be addressed, researchers found that improving the design of electronic health records-which can allow medical assistants to initiate certain conversations prior to the doctor's visit-could play a positive role. Additionally, offering to mail certain screening tests to the patients' homes, instead of making the decision during a patient's visit, could also increase the rates at which patients ended up getting screened.

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