August 26th, 2011 by Jessie Gruman, Ph.D. in Research
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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*
August 11th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
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The American College of Graduate Medical Education has enacted further restrictions on resident work hours. No more than 80 hours per week of work for resident physicians, averaged over one month. And no more than 16 hours of continuous work for first year residents (24 after that), which includes patient care, academic lectures, etc.
Whenever they do this sort of thing, everyone seems excited that it will make everyone safer. After all, residents won’t be working as much, so they’ll be more rested and make much better decisions. It’s all ‘win-win,’ as physicians in training and patients alike are safer.
I guess. The problem of course is that after training, work hours aren’t restricted. There is no set limit on the amount of work a physician can be expected to do, especially in small solo practices, or practices in busy community hospitals.
I understand the imperative to let them rest. I understand that fatigue leads to mistakes. I get it! But does the ACGME get it? Read more »
*This blog post was originally published at edwinleap.com*
July 12th, 2011 by admin in Health Tips
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Feeling tired? If so, it’s not surprising. Fatigue is one of the most common problems people report to their doctors. The Health and Retirement Study of more than 17 million older people ages 51 and up reported recently that 31% said they feel fatigued.
Fatigue is a symptom, not a disease. Different people experience it in different ways. The tiredness you feel at the end of a long day or after a time zone change might feel similar to that resulting from an illness. But fatigue from stress or lack of sleep usually subsides after a good night’s rest, while disease-related lethargy is more persistent and may be debilitating even after restful sleep.
Finding the cause. How do you know if your low-energy is caused by an underlying illness or is the result of stress, poor diet, or lack of sleep? For example, could you have chronic fatigue syndrome? That is an unusual illness and an uncommon cause of persistent fatigue, says Anthony Komaroff, M.D., professor of medicine at Harvard, world-renowned expert on chronic fatigue syndrome, and medical editor of a new Harvard Special Health Report, Boosting Your Energy. About 4 to 8 of every 1,000 adults in the United States suffer from chronic fatigue syndrome, which is about twice as common in women as in men. The causes of chronic fatigue syndrome are still unknown, and there is no accurate diagnostic test. However, scientists have found abnormalities in the brain and peripheral nervous system, in the immune system, and in energy metabolism in people with this syndrome. Read more »
*This blog post was originally published at Harvard Health Blog*
June 26th, 2011 by AndrewSchorr in Health Tips, True Stories
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Hi! Greetings from Breckenridge, Colorado. At 10,000 feet, I am told it is the highest resort town in North America. The Rocky Mountain scenery is breathtaking. But there’s a problem for about one in four of us who visit here, especially people like me who live at sea level. We can get hit with high altitude sickness and a few days ago, I was one of the unlucky ones.
What happens is your body isn’t used to the thin air and your blood has difficulty getting enough oxygen to your body. It usually happens at altitudes over 8,500 feet. You get an ongoing headache, you feel tired, you have insomnia (I was sleepless for two nights!), you could have nausea and certainly fatigue. Drinking lots of water and passing up alcohol can help, but even then some people have problems.
When I finally saw a family doctor – Doctor P.J. – he told me it’s genetic. Some people have trouble “acclimatizing” and others don’t, but there’s no easy way to know who will be affected before you make the climb. Now that I know I have difficulty I will take a prescription medicine (Diamox) ahead of coming up here again.
Doctor P.J. says even Read more »
*This blog post was originally published at Andrew's Blog*
April 13th, 2011 by AndrewSchorr in Opinion, Patient Interviews
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How is it that a person with an illness forgets to take their medicine, or refuses to get a treatment, or forgoes important monitoring? I’ve been thinking about that because someone close to me has hit that “medical fatigue” wall. There has been no effective treatment for their digestive system illness and they are tired of the prods, pokes, and special exams. They just want to live their life and “cope.”
One can understand – especially in a child or teenager. Imagine someone with diabetes. Diet, exercise, monitoring, medication. It can be so tiring. If only the illness – the boogieman or what some call “the beast” could just go away!
But it can’t and it doesn’t. And medical treatments may well be imperfect. They probably are. So do you give up? There is no “right answer,” only a right answer for you. Here are some examples: This week I am interviewing Kathy Sparks of suburban Seattle. Kathy is a nurse who was diagnosed with melanoma on her forearm. It was cut out. Then more was cut out. Then it came back. She had chemotherapy with lots of side effects. A remission followed, and then it came back again, this time in her breast. As time passed doctors gave her only months to live. Unwilling to try to fairly toxic chemo again, she spent time making peace with her impending demise. Read more »
*This blog post was originally published at Andrew's Blog*
