Be Your Own Health Advocate: Ask for Screenings

Rachel Morrell

Be Your Own Health Advocate: Ask for Screenings

Have you ever wondered if the timing of your doctor appointment could affect whether your doctor recommends a life-saving colonoscopy screening or preventive test? A recent study discovered doctors are more likely to recommend screening procedures to their morning patients than their afternoon patients.

Decision Fatigue Affects Doctors’ Recommendations

A new study in JAMA found primary care physicians (PCPs) order more cancer screening tests for patients seen at 8 a.m. than those with appointments later in the day. This is partly due to "decision fatigue," the result of the summative burden of screening discussions earlier in the day, and doctors falling behind in their scheduled appointments.

The University of Pennsylvania’s Perelman School of Medicine and the Wharton School examined data from 2014 to 2016 from 33 primary care practices in Pennsylvania and New Jersey. The researchers discovered primary care physicians ordered colon cancer screening tests for 37 percent of eligible patients with 8 a.m. appointments, but for only 23 percent of patients with later afternoon appointments.

Results were also consistent for breast cancer screenings. Doctors ordered mammograms for 64 percent of eligible patients with 8 a.m. appointments, but for only 48 percent of eligible patients with 5 p.m. appointments.

Decision Fatigue Affects Patient Follow-Through

The JAMA study also found higher screening completion rates for patients who had morning appointments compared to patients who had afternoon appointments. About 28 percent of patients with 8 a.m. appointments completed a colon cancer screening (like a colonoscopy, fecal occult blood test or sigmoidoscopy) within the year, but only 18 percent of patients with 5 p.m. appointments had a colon cancer screening during that time.

Thirty-three percent of patients with 8:00 a.m. appointments got a breast cancer screening within the year, compared to 18 percent of patients who saw their doctor at 5:00 p.m. The study noted a brief increase in screening recommendations and screening completion among patients who had noon appointments, possibly because the lunch hour allowed doctors to get caught up and begin anew.

Take Responsibility for Your Healthcare

What kind of conclusions can you make about doctors’ judgment during afternoon appointments? Are all afternoon appointments a waste of time? Not at all.

Perhaps you can view this data from a different angle and apply some empathy. Decision fatigue can affect anyone of any age or profession, from a quarterback at the end of a game to a criminal judge, or even a mother of toddlers.

Making repeated healthcare decisions is exhausting, and doctors willingly carry a heavy yoke of responsibility. Deciphering symptoms, diagnosing illnesses and prescribing care erodes physical and mental energy as the day continues. Instead of passively relying on your doctor to suggest the preventive screenings and tests for which you are eligible, you can be proactive and do a little research for yourself.

Before your next routine appointment, call your insurance company and ask what screenings and tests are recommended for your gender and age. You can also ask about whether you have met your deductible for the year and get an estimate for any out-of-pocket charges you may incur for the recommended screenings.

As an informed patient, you can make the most of your doctor appointment by:

  1. Bringing a list of recommended preventive screenings
  2. Writing out any questions you may have
  3. Asking your doctor’s recommendation regarding specific tests (colonoscopy vs. stool test)

Remember, you are the best advocate for your health, so don’t wait for your doctor to initiate the conversation about vital routine screenings. Bring up the subject yourself, and be proactive about your care.

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