19 Sep Tired Surgeons Schedule Fewer Surgeries
MedicalResearch.com Interview with:
Gustav Tinghög, PhD
Division of Economics
Department of Management and Engineering, IEI
JEDI-lab: JUDGEMENT, EMOTION, DECISION and INTUITION
MedicalResearch.com: What is the background for this study?
Response: Previous studies have shown that when we get tired, we make decisions without engaging in cognitively demanding reasoning, and we postpone risky or uncertain choices. Previous studies have explored this idea of “decision fatigue” in relation to parole hearing outcomes, failure of health services workers to wash their hands, and the likelihood of physicians prescribing antibiotics.
In our study we wanted to investigate how patient ordering affected decisions scheduled patients for orthpedic surgery (excluding acute cases)
MedicalResearch.com: What are the main findings?
Response: The main finding of the study is that a patient who meets the surgeon at the end of his or her shift is less likely to be scheduled for surgery. Four of ten patients (40.2%) who met the surgeons early in the shift were scheduled for an operation, whereas when the surgeons were near the end of the shift, the figure was just two of ten (21.7%).
Consistent with the notion of decision fatigue the temporal pattern of surgeons’ decision making there was a declining trend in scheduled surgeries both before and after the lunch break. The proportion of patients who were scheduled for surgery was high in the early morning and decreased until lunch break, after which, the proportion was again high and decreased until the end of the afternoon shift.
MedicalResearch.com: What should readers take away from your report?
Response: Decision fatigue is likely to influence medical decision making. Our results show that the tendency to operate is higher when a doctor is relatively well‐rested and decreases as doctors make more and more decisions. This is bad news for patients because it suggests that their treatment is affected by incidental factors and that there is some arbitrariness in decisions taken by the doctors. From a societal point of view, this is an inefficient and arguably unfair use of medical resources.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future studies should explore the role of extraneous factors that can be linked to decision fatigue affect other types of medical decision making in larger samples. Future studies should also explore how interventions such as taking short breaks might alleviate the effect of decision fatigue in medical decision making.
MedicalResearch.com: Is there anything else you would like to add?
Response: By virtue of the scheduling procedure at the hospital, each patient is essentially allocated to a specific time slot of a given doctor at the clinic by chance. Therefore, neither type nor extent of problem or the patient’s individual characteristics should influence the particular sequence of patient appointments for the doctor during the work shift. In this sense, we are exploiting a natural experiment, because a useful control group (first patient appointment during the work shift) arises naturally by the scheduling procedure at the hospital.
The study was conducted in Sweden where we have a publicly funded health care system Thus, physicians have no financial incentives to schedule patients for surgery or not. Our data covers 848 patient appointments during the course of 133 different doctor work shifts.
Persson, E, Barrafrem, K, Meunier, A, Tinghög, G. The effect of decision fatigue on surgeons’ clinical decision making. Health Economics. 2019; 1– 10. https://doi.org/10.1002/hec.3933
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