Don’t make your doctors’ appointments later than 3 pm! Wait till you learn why.

We all know most doctors today are overworked, but until I read an opinion piece by Dr. Jeffrey A. Linder in The New York Times, I never realized their demanding schedules could have such deleterious effects on OUR HEALTH.   “To do everything we’re supposed to for a typical daily patient load, primary care doctors should spend 11 to 18 hours a day providing preventive and chronic care, never mind addressing new problems,” writes Dr. Linder, professor and chief of the division of general internal medicine and geriatrics at the Feinberg School of Medicine at Northwestern University in Chicago, IL.

No surprise Dr. Linder’s focus starts to fade around 3 most afternoons, and he grabs a snack and coffee to “stay sharp” for the patients he’s yet to see.  But now a new study reveals that Dr. Linder’s “3 o’clock fade” is a real phenomenon among doctors, and it could affect patients’ health. Here’s what happens: As health care providers make more and more choices throughout the day, “decision fatigue” sets in and they may start to take the easy way out. They ordered 10 percent to 15 percent fewer breast and colon cancer screenings, for example,  for patients they saw later in the day, compared to those with appointments around 8 a.m., according to the study of 33 primary care practices, published in JAMA (Journal of the American Medical Association) Network Open. All the patients were due for screening.

Dr. Linder reports that when he and fellow researchers conducted their own study in 2014,  they “found doctors prescribed fewer unnecessary antibiotic prescriptions for respiratory infections first thing in the morning, but that unnecessary prescriptions gradually increased over the day.”  The exact same doctor, caring for the exact same patient, had a 26 percent higher chance of writing an antibiotic prescription at 4 p.m. compared to 8 a.m.As doctors got more fatigued, they defaulted to the easy thing: just writing an antibiotic prescription rather than taking the time to explain to patients why it is not necessary. As the day went on, doctors’ fears of disappointed, dissatisfied, angry or confrontational patients may have loomed larger and larger. The will to confront those fears may have dwindled and more patients left the clinic with unnecessary antibiotics,” Dr. Linder writes in his Times piece.

Doctors also prescribed fewer flu vaccinations and more opioids for back pain later in the day. “We doctors like to think of ourselves — and the public might like to think of us — as rational decision makers, but depending on the time of day, treatments change,” Dr. Linder confesses.  He offers a few solutions in his column, including“ improving the efficiency of the current generation of electronic health records” and paying doctors based on the quality of care they deliver rather than on face-to-face visits.

Dr. Linder advises patients who can’t get to their doctors early in the morning to “learn about screenings you might be eligible for, and work with your doctor to figure out which are right for you.”  As for me, I’m sticking to early morning appointments.