A Steadier Signal for Decision Fatigue, in Doctors' Prescribing Pads

This study tested whether a decision-fatigue-like pattern shows up somewhere with less scope for the scheduling confounds that complicated the parole study: primary care doctors prescribing antibiotics. Across almost 22,000 visits for acute respiratory infections at practices affiliated with a Boston teaching hospital, the rate of antibiotic prescribing rose steadily as each clinical session wore on, doctors were 26 percent more likely to prescribe by the fourth hour than the first, and this held true even for diagnoses, like plain viral bronchitis, where antibiotics are never medically indicated. Prescribing rates dipped slightly after lunch breaks before climbing again through the afternoon session.

As with the parole study, this is observational, and some researchers have suggested the pattern could partly reflect patients pushing harder for a prescription as their own frustration builds through a long wait, rather than the doctor's fatigue alone, sometimes called 'patient negotiation fatigue'. What makes it a useful complement to the more contested judicial data is scale, nearly 22,000 real clinical decisions, and a genuinely undesirable outcome, unnecessary antibiotic prescriptions carry real medical costs, giving the pattern practical stakes beyond the theoretical debate about whether decision fatigue is real.