Decision fatigue looms large among clinicians

Spending the day making crucial decisions that affect people’s lives is mentally exhausting, and no one understands this better than doctors. Consequently, doctors too are no strangers to decision fatigue.

Decision fatigue is the idea that repeated decision-making saps your mental energy, reducing your willpower and self-control, and setting you up to prefer expedient or even irrational choices. It’s why quarterbacks make more questionable calls toward the end of the game, and why grocery stores put candy and snacks in the checkout lane—by the end of a shopping trip, mom is too pooped from bargain shopping to resist little Johnny’s repeated pleas for M&M’s.

Consider this common scenario: A patient with flu-like symptoms visits a doctor. The doctor, who is nearing the end of a long shift, writes a prescription for an antibiotic and sends the patient home. Although the doctor suspects a viral infection, he prescribed the antibiotic to provide the patient with a decisive (albeit inappropriate) solution and to bring the visit to a speedy end.

A study published in JAMA Internal Medicine found that physicians make more of these inappropriate decisions as the day goes on. In this study of primary care physicians, decision fatigue increased their likelihood of prescribing antibiotics for patients presenting with acute respiratory infections as clinical sessions wore on.

The study found that antibiotic prescriptions were more frequent in the later hours of the physician’s shift, and in most cases weren’t necessary for the patient. The study authors concluded that these findings were “consistent with the hypothesis that decision fatigue progressively impairs clinicians’ ability to resist ordering inappropriate treatments.”

Physicians aren’t the only ones who suffer from decision fatigue. Judges are known to make less favorable rulings as their day goes on. Albert Einstein reportedly wore an identical suit every day, “So that I don’t waste any brainpower in the mornings deciding which set of clothes to wear.”

According to the authors of the JAMA Internal Medicine article, possible remedies for physician decision fatigue include time-dependent decision support, modified schedules, shorter sessions, mandatory breaks, or snacks (perhaps M&M’s?).