Scientists at Brigham and Women’s Hospital (BWH) in Boston discovered that physicians seem to get worn down over the course of their clinical sessions, and tend to be more likely to prescribe antibiotics later in the day for acute respiratory infections (ARI).

Lead study author Jeffrey A. Linder, MD, MPH, a physician and researcher in the Division of General Medicine and Primary Care at BWH, and colleagues looked at billing and electronic health record (EHR) information for physician clinic visits to 23 primary care offices during a 17-month period. They then identified the patients’ visit times, antibiotic prescriptions and chronic illnesses.

More than 21,000 ARI visits by adults were analyzed, which occurred during two sessions: 8am to 12pm, and 1pm to 5pm. The researchers discovered that physicians prescribed antibiotics more often throughout the afternoon clinic sessions, representing a five percent increase in the number of antibiotic prescriptions at the end of a clinic session compared to the start.

“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 Linder in a statement.

Linder suggests that different schedules, shorter clinical sessions, and more frequent breaks can remedy this problem.

The findings of the study are published in JAMA Internal Medicine.