Good things happen when judges and doctors are rested and well fed

When we’re tired we take the easy way out. Psychologists call this “decision fatigue,” the idea that the quality of our decisions deteriorate over time as our brains get tired. No surprise there. The interesting bit, however, is that it applies not just to you and me, but also to judges and doctors acing in their professional capacity.

For example, a well-reported study of judicial decision making found that as court sessions wore on judges were far more likely to deny parole. The reason? Denying parole is what’s normally done. Thus as each case comes before the court, denying an application for release is the safe, easy option. To buck that trend and grant parole takes intellectual energy. Therefore, the study found, if you want out of jail your chances are “greater at the very beginning of the work day or after a food break than later in the sequence of cases.”

Similarly, with doctors, researchers asked the question whether decision fatigue would increase the likelihood of inappropriately prescribing antibiotics as the day wore on. And sure enough, in a study called Time of Day and the Decision to Prescribe Antibiotics, they found that inappropriate antibiotic prescribing “increased throughout the morning and afternoon clinic sessions … consistent with the hypothesis that decision fatigue progressively impairs clinicians’ ability to resist ordering inappropriate treatments.” (Chart below.)

The reason: Issuing the prescription is “again, the easy, safe, practice” because it conforms to a “perceived or explicit patient demand, a desire to do something meaningful for patients, a desire to conclude visits quickly, or an unrealistic fear of complications.”

The remedy involves doctor and patient. The physicians job, the authors suggest, is to modify their schedules, take mandatory breaks, or snack more frequently. Our job, as patients, is to stop asking for antibiotics and realize that they’ll be prescribed when appropriate.

And perhaps bring to the appointment, along with our insurance card, an apple for the doctor.

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