“Decision Fatigue” Leading to Possible Misdiagnosis, Medical Errors

Monday, October 6th, a study was published in JAMA Internal Medicine which examined a doctor’s likelihood to prescribe unnecessary antibiotics based on time of day. The researchers recalled past studies which analyzed the decision making of judges, suggesting that they are more inclined to deny parole later in the day. The goal of this particular study was to determine if, as the day goes on, doctors’ decisions become similarly skewed.

Reuters Health explained in an article last week, “The researchers compared electronic health records and billing data for patients who visited a primary care practice between 2011 and 2012 with symptoms of an acute respiratory infection.” Studying respiratory infection visits allowed researchers to strategically look at prescribing practices. There are types of respiratory infections, like strep throat or pneumonia, that often require antibiotics; however, other types of respiratory infections, such as the flu, should never be treated with antibiotics according to national guidelines. There are various types of infections, some requiring antibiotics and some that should never be treated with antibiotics. Respiratory infections allowed the researchers to determine if, in similar medical cases, doctors were prescribing antibiotics inconsistently or against guidelines.

The study looked at almost 22,000 respiratory infection visits, divided into two four hour shifts, 8:00am-noon and 1:00pm-5:00pm. Each shift showed that antibiotic prescribing went up for diagnoses that should and should not have been treated with medication. The study found, “Overall, doctors were 26 percent more likely to prescribe an antibiotic in the fourth hour of a shift compared to the first hour.” The researchers call this ‘decision fatigue.’

Dr. Jeffrey A Linder, coauthor of the research letter told Reuters Health, “Just as an observation it kind of makes sense, doctors are human too and we get tired over the course of the day and tend to make worse-appearing decisions.” These worse-appearing decisions, pose a concern for patients and doctors alike. Linder offered suggestions as to how this problem could be corrected, one of which included the implementation of computerized decision support.

From a legal standpoint, these findings are somewhat alarming. Misdiagnosis, surgical errors, and medical malpractice cases typically originate from an error made on the part of a medical professional. ‘Decision fatigue’ is a major concern in this regard. If prescribing practices were skewed as much as 26 percent in a four hour shift, fatigue has great potential to taint the quality of other, more critical decisions.

Furthermore, when considering medical professionals who work lengthier shifts than 4 hours, it is easy to imagine that the quality of decisions would be compromised even more significantly. Though strides have been made to shorten the shiftwork of medical professionals, many still work up to 80 hours per week.

It is important to be aware of this problem and understand that fatigue inevitably affects decisions. If you feel that you were injured or harmed due to a misdiagnosis or other medical error, decision fatigue may have been a contributing factor. Talk to an attorney that specializes in malpractice cases and they will be able to work with experts to evaluate your situation. Most lawyers offer free consultations and will be willing to have an honest discussion with you regarding the potential of your case.

Contact the Marrone Law Firm, LLC toll-free at 866-732-6700 or 215-732-6700 to schedule a free consultation today. Our attorneys are available to discuss your legal matter at your convenience.

Sources:

http://www.reuters.com/article/2014/10/07/us-health-psychology-antibiotics-idUSKCN0HW1IG20141007

http://archinte.jamanetwork.com/article.aspx?articleid=1910546