Exhausted by morning and afternoon clinic sessions, physicians are more likely to prescribe antibiotics for respiratory infections later in the day, says a study.
Researchers found that doctors appeared to "wear down" and the rate of prescribing antibiotics increased as the day passed.
"Clinic is very demanding and doctors get worn down over the course of their clinic sessions," said Jeffrey A Linder, researcher at Brigham and Women's Hospital (BWH) in Boston.
"In our study we accounted for patients, the diagnosis and even the individual doctor, but still found that doctors were more likely to prescribe antibiotics later in their clinic session," Linda pointed out.
For the study, the researchers merged billing and electronic health record (EHR) data for patient visits to 23 different primary care practices over the course of 17 months.
The team identified visit diagnoses using billing codes and, using EHRs, identified visit times, antibiotic prescriptions and chronic illnesses.
They analysed over 21,000 visits by patients which occurred during two four-hour sessions between 8 a.m. to noon and 1 p.m. to 5 p.m.
They found that antibiotic prescriptions increased throughout the morning and afternoon clinic sessions.
"This corresponds to about five percent more patients receiving antibiotics at the end of a clinic session compared to the beginning," Linder noted.
The study appeared in JAMA Internal Medicine.
