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Overworked doctors 'administer fewer life-saving cancer tests in the afternoon'

Tired doctors are less likely to correctly diagnose cancer if your appointment is in the afternoon, a study suggests. Researchers found they were more likely to order a lifesaving cancer test at the start of the day compared with appointments closer to home time.

Experts believe “decision fatigue” means they are less likely to put a patient forward for the routine screening.

Early diagnosis is seen as key to improving Britain’s cancer survival rates which lag behind most of Europe.

Scientists analysed data on 52,000 US patients who were eligible for a breast cancer of bowel cancer screening test.

The study found 64% of eligible patients seen at 8am were ordered the breast screening test compared to 48% seen at around 5pm.

For bowel cancer 37% got the test during appointments at the start of the day compared to 23% with appointments near the end.

Lead author Esther Hsiang of Pennsylvania University, said: “Our findings suggest that future interventions targeting improvements in cancer screening might focus on time of day as an important factor in influencing behaviours.

Tests are vital to cancer diagnosis (Image: Getty) Read More Ex-Mum of the Year cleared of murdering husband after knifing him in heart “We believe that the downward trend of ordering may be the result of ‘decision fatigue,’ where people may be less inclined to consider a new decision after they’ve been making them all day.

“It may also stem from overloaded clinicians getting behind as the day progresses.”

It comes as the NHS staffing crisis is seeing overworked GPs see more patients per day than ever before.

Lunchtime seemed to give GPs a boost in enthusiasm as there was a brief spike in screening test orders around noon.

At 11am 49% of patients got them which rose to 56% at midday.

Other than this rates fell during the course of the day.

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said: “UK GPs are under more pressure than ever before as patient numbers rise and diseases are becoming more complex - at the same time as we have a severe shortage of family doctors.

“But GPs will always aim do the very best we can for every single patient we see, and patients in the UK should be assured that the care they receive should not be affected by the time of day of their appointment.

“GPs are acutely aware of how important it is to identify symptoms of cancer in a timely way and we are doing a good job, with 75% of patients found to have some form of cancer referred after only one or two consultations.

“But we also need more investment in diagnostic tools to help us detect early cancers that have no symptoms at all.”

Doctors with stacked-up appointments are under increasing pressure as the day goes on (Image: Getty) Read More Freddie Starr dead: Comic 'feeling okay' in last Facebook post before death Scientists suggest doctors should be “nudged” by computer systems which prompt them to respond “yes” or “no” whether a screening test should be ordered.

Previous studies on rates of flu vaccinations offered showed this can reduce decision fatigue.

Co-author Mitesh Patel, director of the Penn Medicine Nudge Unit, said: “Our new study adds to the growing evidence that time of day and decision fatigue impacts patient care.

“In past work, we’ve found that nudges in the electronic health record can be used to address these types of gaps in care, which we suspect will be the case here.

“Future research could evaluate how nudges may be implemented in order to improve cancer screening.”

Prof Stokes-Lampard added: “Every day over one million patients are seen in general practice and the number of patients seen by GPs is escalating.

“There is a limit beyond which we can no longer guarantee safe care, and more must be done to support GP wellbeing so that hard-working and dedicated family doctors can continue doing the job that they are highly trained and skilled to do.”

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