When it’s time to schedule a medical appointment or procedure, it’s natural to try to book a time that is convenient for you. Maybe you prefer first thing in the morning. Or right after work. I try to get the first appointment after the doctor’s lunch break. Although convenience is nothing to scoff at, it turns out that when you receive care can impact your health. So, what is the best time of day for medical care?
The level of care can worsen as the day progresses.
In an ideal world, patients should receive quality medical care any time of day or night. But, unfortunately, that is often not true. Fatigue and time constraints can negatively impact the ability to perform at one’s best and to make good decisions. In fact, several studies show that the level of care diminishes as the day progresses – read on for some examples.
What factors contribute to diminishing levels of care?
Mental and physical fatigue can impair performance.
Doctors’ work is mentally and physically exhausting, particularly for those who work long hours or overnight shifts. Unfortunately, doctors’ ability to provide top-notch care can be impaired by mental and physical fatigue, which can cause:
- Slowed reflexes and responses
- Impaired decision-making and judgement
- Impaired hand-to-eye coordination
- Blurry vision
- Short-term memory problems
- Poor concentration
- Reduced ability to pay attention to the situation at hand
Of course, patients can suffer from physical and mental exhaustion as well. Fatigue can make it hard for patients to understand their doctors, make decisions and remember important medical information. And it can make patients eager to make their appointments as short as possible.
Decision fatigue clouds thinking.
As the work day progresses, doctors and patients can develop decision fatigue – the tendency to make poor decisions after many hours of making decisions. Why? Because constant decision-making taxes the executive functioning of the brain, making it hard to make good decisions. And, this fatigue can occur after making a series of big and/or small decisions throughout the day. So, it’s not only a concern for doctors who make important health related decisions, it’s a concern for patients too.
Time-squeezed appointments lead to rushing.
As the day progresses, doctors can fall more and more behind schedule, encouraging them to rush through already time-squeezed appointments. And patients may feel rushed themselves, wanting to get home as quickly as possible. Since there is less time for conversations, doctors and patients may defer conversations and decisions to a future appointment or skip them altogether.
How does the time of day patients receive medical care impact their health?
Clearly, patients can suffer when these, and other issues, make it hard for doctors to practice at their highest standards. For example, research shows that medication errors increase when health care professionals feel rushed or fatigued (among other factors).
Additionally, experts consider time constraints, such as rushed appointments, a major cause of missed or wrong diagnoses. Why? It’s natural for everyone, including doctors, to rely on mental shortcuts when time and/or resources are limited. In these instances, doctors can make quick assumptions which not only increases the likelihood of missed disease warnings signs, but it can lead to poor decision-making as well.
Not only does fatigue and rushing degrade the level of care, research shows that care degrades as the workday progresses. How can these not be related?
Research shows the time of day for medical care impacts the quality of care.
Below are a few examples that illustrate how the time of your appointment or procedure can impact your health.
Appointment time can impact the likelihood of cancer screening.
Researchers recently analyzed patient visits of 33 primary care practices over a 2-year period. These visits included 19,000+ patients eligible for breast cancer screening and 33,000+ patients eligible for colorectal cancer screening. Interestingly, as the day progressed, doctors became less likely to order cancer screening tests. Furthermore, patients seen later in the day were less likely to complete their recommended screening within 1 year of their appointments.
Here is a summary of the results:
What factors contribute to this gap?
The researchers theorize there are likely many patient and doctor factors at play. As the workday progresses, doctors can fall behind schedule, leading to shorter appointments in the afternoon. In these rushed appointments, doctors may not discuss cancer screening. Additionally, doctors with decision fatigue may be less likely to discuss cancer screening with patients simply because they’ve already done it repeatedly throughout the day. Furthermore, if/when patients seen earlier decline screening, doctors may be reluctant to bring up the topic later in the day. Although they found no significant characteristics differences between patients who had appointments throughout the day, they theorize that some patients who have later appointments may be anxious to finish the appointment and may therefore decline a conversation about cancer screening.
Time of day influences likelihood of receiving a flu shot.
A study of flu vaccination rates for 96,000 patients at 11 primary care practices found that the rates of vaccines significantly declined as the day progressed. Unsurprisingly, the vaccination rate increased when practices used EHRs that prompted medical assistants to ask patients about flu vaccines and included templates that made doctor approval of vaccinations easier.
A summary of the results:
Nighttime surgeries have higher death rates.
An evaluation of mortality rates associated with over 41,700 elective and emergency surgeries found a significant increase of death when patients had procedures at night.
After adjusting for patients’ age and risk scores, patients operated on between 11:30 pm – 7:29 am were 2.17 times more likely to die than those who had surgeries during regular daytime hours. Additionally, patients operated on later in the workday or in the evening were 1.43 times more likely to die than those who had daytime surgeries.
The researchers theorize that this increase in mortality has many potential causes, including OR staff fatigue, overnight hospital staffing issues, delays in treatment or the patient being too sick to wait for a postponed treatment.
A few more examples…
Research shows that patients who see primary care doctors later in the day are more likely to receive unnecessary antibiotics. And those who see doctors later in the day for low back pain were significantly more likely to receive an opioid prescription. Lastly, one study found that health care providers wash their hands less often towards the end of their shifts, increasing the risk of the transfer of germs to patients.
What should you do?
Clearly, schedule your medical appointments and procedures for as early in the day as possible.
But, no matter what time of day you see a doctor, it’s important for you to participate in the process, by:
- Keep track of all of your medical information, including test and lab results, diagnoses, treatments, immunizations, side effects and symptoms. Bring this information with you to every appointment.
- Prepare for appointments by writing down your concerns and questions.
- Take detailed notes during each appointment. Record the conversation if you think that will help you (ask first!).
- If you don’t understand something, ask your doctor to repeat the information.
- Speak up if something doesn’t seem right.
- Follow each doctor’s recommendations. If you think you cannot or will not do so, discuss this with your doctor.
Can you avoid nighttime surgeries?
Clearly, if you or a loved one needs emergency surgery at night, then you can’t avoid late night surgery. But, the unavailability of surgeons and operating rooms routinely causes delays. If your surgeon wants to postpone your daytime surgery to a nighttime slot, ask if you can reschedule for another day. I strongly recommend you do not consent to late day or nighttime surgery if there is any possibility of scheduling your operation between 7:30 am – 3:30 pm.
For more tips for getting better care, read these blog posts:
- 10 Tips for a Better Medical Appointment.
- Why Take Detailed Notes at Doctor Appointments?
- Should You Record Medical Appointments?
- Understanding Medical Information Is Harder Than Most Realize.
- How Can You Get the Best Healthcare? Actively Participate!
- Doctors’ Stress Impacts Patients.
- Doctor Burnout Can Impact Your Health.
- 10 Tips to Communicate Better with Doctors.