Do you suffer from decision fatigue when you are sick or anxious or overwhelmed by bad health news? Does your doctor make less well-reasoned decisions about the 10th patient she sees before lunch? How about the surgeon during his second operation of the day? How about the radiologist reading the last mammogram in a daily batch of 60?
A provocative article by John Tierney in Sunday’s NYTimes Magazine adds a new layer of complexity to the body of knowledge collecting around decision-making processes. Considerable news reporting has focused on how cognitive biases influence our judgment and how many of us experience the abundance of choices available to us as a burden rather than a privilege. This article adds to that understanding: Our decision-making abilities appear to be powerfully affected by the demands of repeated decision making as they interact with depleted blood glucose levels. That fatigue mounts over a day of making decisions and as blood glucose levels fall between meals. In response, we tend to either make increasingly impulsive decisions without considering the consequences or to make no decisions at all. Tierney describes a study analyzing 1,100 parole decisions by judges over the course of a year: “Prisoners who appeared early in the morning received parole about 70 percent of the time, while those who appeared late in the day were paroled less than 10 percent of the time.”
The effects reported in the article were Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
I used to think they didn’t, but they do.
Clinical judgment is the application of individual experience to the variables of a patient’s medical presentation. It’s the hard-worn skill of knowing what to do and how far to go in a particular situation. It’s having the confidence to do nothing. Clinical judgment is learned from seeing lots of sick people. Good clinical judgment is when the gifted capacity of reasoning intersects with experience. Some doctors have better judgment than others.
Aristotle called this phronesis – or practical judgment.
Patients have practical judgment. We often can tell when something’s amiss with our own body. Things feel different or look different. Taking action on these observations is how we exercise judgment as patients.
Parents of children with central venous lines, for example, can often identify the early signs of infection before fever has ever appeared. They know the subtleties of their child’s behavior. The same goes for children with epilepsy. People with diabetes increasingly have the latitude to apply judgment to the management of their disease. This tends to be quite defined, however, with fixed variables and limited options for intervention. Read more »
*This blog post was originally published at 33 Charts*
Two new surveys take the temperature of the primary care working environment.
In the first, a collaboration between the Medical Group Management Association and the Association of Staff Physician Recruiters, recruiters took a median of six months to fill positions for internal medicine or family practice physicians, according to the In-House Recruitment Benchmarking Survey: 2010 Report Based on 2008 Data.
Among the findings:
– It cost less to recruit specialists, due to the economic downturn and a 30% rise in the use of Internet job boards as a primary recruitment method.
– It takes longer to fill a position in non-metropolitan areas, where the impact of the primary care shortage is greatest. Read more »
*This blog post was originally published at ACP Internist*