Doctors are highly trained professionals, but they can still make mistakes, especially when they are tired. A new study found that doctors were more likely to prescribe antibiotics for acute respiratory infections when they were near the end of their shifts.

The research study was published Oct. 6 in JAMA Internal Medicine.

"Clinic is very demanding and doctors get worn down over the course of their clinic sessions. 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," said Jeffrey A. Linder, M.D., MPH, the lead author of the study and a researcher at Brigham and Women's Hospital in Boston, Mass.

The researchers studied health records at 23 different facilities for the past 17 months. There were 21,000 cases of acute respiratory infection in adults in these records. Cross-referencing the cases of ARI with the time of the clinical visit, the researchers found that doctors are up to 25 percent likelier to prescribe unnecessary antibiotics to treat an upper respiratory infection later in their shifts than early on in their shifts. This means that toward the end of the shift, a patient is 5 percent likelier to be prescribed antibiotics for an acute respiratory infection.

"Their antibiotic prescribing is inconsistent with the diagnosis they're giving the patient. That 25 percent to 26 percent should be closer to zero," Linder said.

It's not surprising that doctors are subject to wear and tear, but it is unsettling that the number of unnecessary prescriptions shoots up toward the end of the day. Overprescription of antibiotics can lead to an increase in antibiotic-resistant bacteria, as well as increasing the cost of health care.

Linder recommended that doctors take more breaks throughout the day, schedule shorter clinical sessions, or change their schedules to avoid burnout later in their session.

Antibiotics are recommended to treat some types of respiratory infection, such as acute otitis media (ear infection), or bronchitis caused by pertussis. However, for most ARIs in adults, antibiotics are not recommended. Many ARIs are caused by viruses, not bacteria, and antibiotics will not have any effect. Overuse of antibiotics increases the likelihood of complications, such as an allergic reaction.

More research needs to be done on this topic, but it seems like it would be good for doctors to have more break time.

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