Doctors and decision fatigue
nytimes.com
nytimes.com
When other researchers took a closer look, it turned out that in each session, prisoners without attorneys (who are less likely to be granted parole) were scheduled last, just before the breaks. After accounting for this and several smaller factors, the original conclusion could no longer be supported. [1]
[1] https://journals.sagepub.com/doi/10.1177/1745691616652873
2. For income vs. IQ, there will be high variance. This is obvious.
3. He intentionally omits R-values for many of his plots to hide their predictive power. Even smaller R-values, given a large sample size and good p-test, show the power of a correlation.
https://www.goodreads.com/book/show/35412097-when
And direct from the author some insights from the book:
'Afternoons are the Bermuda Triangles of our days. Across many domains, the trough represents a danger zone for productivity, ethics, and health. Anesthesia is one example. Researchers at Duke Medical Center reviewed about 90,000 surgeries at the hospital and identified what they called “anesthetic adverse events”— either mistakes anesthesiologists made, harm they caused to patients, or both. Adverse events were significantly “more frequent for cases starting during the 3 p.m. and 4 p.m. hours.” The probability of a problem at 9 a.m. was about 1 percent. At 4 p.m., 4.2 percent. In other words, the chance of something going awry was four times greater during the trough than during the peak. On actual harm (not only a slip up but also something that hurts the patient), the probability at 8 a.m. was 0.3 percent — three-tenths of one percent. But at 3 p.m., the probability was 1 percent — one in every one hundred cases, a threefold increase. Afternoon circadian lows, the researchers concluded, impair physician vigilance and “affect human performance of complex tasks such as those required in anesthesia care.”'
https://www.linkedin.com/pulse/youre-more-likely-screw-up-af...
Ps: I, on the other hand, am really more productive and attentive to details after lunch and specially after 2pm. Mornings for me are just good for physical activities..
> I am still attached to every study that I cited, and have not unbelieved them, to use Daniel Gilbert’s phrase. I would be happy to see each of them replicated in a large sample. The lesson I have learned, however, is that authors who review a field should be wary of using memorable results of underpowered studies as evidence for their claims.
So it sounds like stands by the claims in the book. If that's the case, then I'm not sure what would be in a second edition.
For example patients with more severe illness could be more eager to see the doctor asap, and therefore be more likely to take the morning appointments, skipping work?
Patients will probably also worry about doctors getting tired, and try to schedule accordingly. I know I do worry about that kind of thing.
No doubt doctors also do get tired, but perhaps, like the judges, they also arrange their schedules accordingly?
Any earlier, the night people won't be well-rested.
11am, the morning people become hungry for lunch and impatient.
After lunch, anyone who overate will be sleepy.
By the time everyone's digested their lunch, the older morning people are fading for the day.
10-11am is the golden hour.
It doesn't matter what you say or how you say it (within reason) if you're battling against your audience's metabolism the whole time.
I've taken to just getting up and walking away for my 10 minutes. I have to piss. I need a coffee, or some water, or just the opportunity to go and breath some other stale air in some other corner of the office (I work full-time remote, so it's generally my own stale air, but the point remains). How is this lost on so many people? It strikes me as being so basic and so obvious and I feel like I invariably end up looking like an asshole because I can't sit in a chair and listen to people fill a volume of space with their words for 2 hours straight.
And those are the run of the mill self-lovers. Real pros like Fidel Castro and others of the ilk could go solo for up to 7 hours.
(The other day heard from someone who attended one of those speeches. Not a happy memory, for some reason.)
The evidence suggests that this extends far beyond cognitive and psychological health impacts. For example, the author notes that there is a 24% increase in heart attacks the day after we lose an hour of sleep during daylight savings. This is just the tip of the iceberg, in my opinion.
Given these mental and physical risks, it is insane that we allow physicians to routinely work shifts that endanger themselves and lead to measurable drops in their performance.
How did the author directly attribute those stats to the "lost" hour of sleep? Even apart of the fact that people don't necessarily lose an hour of sleep, there could be many other reasons. It sounds like a case of conflating causality with correlation.
If you're interested or skeptical, I would highly recommend this book. It's from the "Sleep Loss and the Cardiovascular System" section of Chapter 8. He includes chapter endnotes discussing sources.
I highly recommend people read it. I've gone from getting into bed about 11 and waking up around 6, to getting into bed at 9 and waking up before my alarm clock even goes off, and having a 20 minute nap at lunch. The difference in my mood and energy levels, and most amazingly memory, has been stark. I miss out on an hour of reading or games, but I feel like I actually have more time because I'm alert - not in that state of flux where I'm gormlessly staring at my book or computer with nothing actually happening in my head. You won't realise how sleep deprived you are until you're not, and I would never have changed my perspective if I wasn't given the statistics that he presents in this book.
"They found that the likelihood of a favourable ruling peaked at the beginning of the day, steadily declining over time from a probability of about 65% to nearly zero, before spiking back up to about 65% after a break for a meal or snack."
https://www.theguardian.com/law/2011/apr/11/judges-lenient-b...
Hospitalization with acute myocardial infarction during Transcatheter Cardiovascular Therapeutics meeting dates was associated with lower 30‐day mortality, predominantly among patients with non–ST‐segment–elevation myocardial infarction who were medically managed.
However, at where I live only doctors working with trauma/ER work long hours. From what I understand, that’s mostly to work around the overhead of context switch and patient hand over. For my friend, a lot of stress came from the responsibility, which might not be well distributed across specializations (hence the insurance premiums, etc).
It turns out that doctors are people too. So I completely agree an AM appointment is your best bet if you want to get the best service from the doctor.
I wish the paper tried to differentiate which of these two it was. My guess is that it would have more to do with falling behind schedule than decision fatigue. When you are already behind schedule, you at least subconsciously try to do stuff that minimizes your time. Having a long talk about required screening or arguing about antibiotics may not feel very worthwhile to you when you have 6 patients that have been waiting an hour for you.