Suchergebnisse

The depleting effect of repeated decision making is often referred to as decision fatigue. Understanding how decision fatigue affects medical decision making is important for achieving both efficiency and fairness in health care. In this study, we investigate the potential role of decision fatigue in orthopedic surgeons decisions to operate, exploiting a natural experiment whereby patient allocation to time slots is plausibly randomized at the level of the patient. Our results show that patients who met a surgeon toward the end of his or her work shift were 33 percentage points less likely to be scheduled for an operation compared with those who were seen first. In a logistic regression with doctor-fixed effects and standard errors clustered at the level of the doctor, the odds of operation were estimated to decrease by 10.5% (odds ratio=0.895, pamp;lt;.001; 95% CI [0.842, 0.951]) for each additional patient appointment in the doctors work shift. This pattern in surgeons decision making is consistent with decision fatigue. Because long shifts are common in medicine, the effect of decision fatigue could be substantial and may have important implications for patient outcomes. ; Funding Agencies|Ostergotland County Council (ALF project); Ragnar Soderberg foundation; Marianne and Marcus Wallenberg foundation [MMW2014.0187]

Background and purpose — There is increasing evidence that several commonly performed surgical procedures provide little advantage over nonoperative treatment, suggesting that doctors may sometimes be inappropriately optimistic about surgical ben- efit when suggesting treatment for individual patients. We investi- gated whether attitudes to risk influenced the choice of operative treatment and nonoperative treatment. Methods — 946 Swedish orthopedic surgeons were invited to participate in an online survey. A radiograph of a 4-fragment proximal humeral fracture was presented together with 5 differ- ent patient characteristics, and the surgeons could choose between 3 different operative treatments and 1 nonoperative treatment. This was followed by an economic risk-preference test, and then by an instrument designed to measure 6 attitudes to surgery that are thought to be hazardous. We then investigated if choice of non-operative treatment was associated with risk aversion, and thereafter with the other variables, by regression analysis. Results — 388 surgeons responded. Nonoperative treatment for all cases was suggested by 64 of them. There was no significant association between risk aversion and tendency to avoid surgery. However, there was a statistically significant association between suggesting to operate at least 1 of the cases and a "macho" atti- tude to surgery or resignation regarding the chances of influenc- ing the outcome of surgery. Choosing nonoperative treatment for all cases was associated with long experience as a surgeon. Interpretation — The discrepancy between available evidence for surgery and clinical practice does not appear to be related to risk preference, but relates to hazardous attitudes. It appears that choosing nonoperative treatment requires experience and a feel- ing that one can make a difference (i.e. a low score for resigna- tion). There is a need for better awareness of available evidence for surgical indications.