A recent study published in JAMA Network Open discovered primary care physicians (PCPs) are more likely to order cancer screening tests for patients with morning appointments rather than afternoon appointments. This is partly due to “decision fatigue,” the result of the summative burden of screening discussions in earlier appointments, and doctors falling behind as their shift progresses.

The study analyzed data from 33 primary care practices in New Jersey and Pennsylvania between 2014 and 2016. Clinicians ordered colon cancer screening tests for 37 percent of eligible patients with 8 a.m. appointments but only 23 percent of patients with later afternoon appointments.

Results were also consistent for breast cancer screenings. Doctors ordered mammograms for 64 percent of eligible patients with 8 a.m. appointments but only 48 percent of eligible patients with 5 p.m. appointments.

The study proposed three reasons why doctors suggested cancer screenings less often in the afternoon:

Decision Fatigue

Decision fatigue, defined as the depletion of self-control and active initiative, happens in every profession, and doctors are no exception. Doctors must make countless decisions regarding patients’ health. As the day goes on, physicians are more likely to forego a cancer screening discussion because they have already initiated these conversations earlier in the day.

Falling Behind in Scheduled Appointments

Appointments at the end of the afternoon tend to be shorter because doctors often are behind schedule. One way to abbreviate patient visits is to address the reason for the appointment only and delay the cancer screening discussion for next time.

Conserving Mental Energy

If morning patients decline cancer screenings, doctors may be less likely to suggest cancer screenings for patients with later appointments. The brain is very good at conserving energy, and meeting with resistance causes the brain to find more accessible pathways. In this case, the easier pathway would be to avoid suggesting the screening.

What kind of conclusions can we draw about doctors’ judgment during afternoon appointments? Are all afternoon appointments a waste of time? Not at all.

Perhaps we can view this data from a different angle. Decision fatigue can affect anyone of any age or profession, from a quarterback at the end of a game to a criminal judge, or even a mother of toddlers.

Making repeated healthcare decisions is exhausting, and doctors willingly carry a heavy yoke of responsibility. Deciphering symptoms, diagnosing illnesses and prescribing care erodes physical and mental energy as the day continues. Instead of passively relying on your doctor to suggest the preventive screenings and tests for which you are eligible, you can be proactive and do a little research for yourself.

Before your next well appointment, call your insurance company and ask what screenings and tests are recommended for your gender and age. You can also ask about whether you have met your deductible for the year and get an estimate for any out-of-pocket charges you may incur for the recommended screenings.

As an informed patient, you can make the most of your doctor appointment by:

1. Bringing a list of recommended preventive screenings.
2. Writing out any questions you may have.
3. Asking your doctor’s recommendation regarding specific tests (colonoscopy vs. stool test).

Remember, you are the best advocate for your health, so don’t wait for your doctor to initiate the conversation about vital routine screenings. Bring up the subject yourself and be proactive about your care.

The Robert G. Kardashian Center for Esophageal Health is the newest addition to the UCLA Vatche and Tamar Manoukian Division of Digestive Diseases. The center is a collaboration of UCLA’s experts in gastroenterology, oncology, anesthesiology, surgery, pathology, radiology and pediatrics, all dedicated to the prevention, diagnosis and patient-centered treatment of esophageal diseases.

Robert Kardashian was a prominent businessman and lawyer from Los Angeles. He is most remembered for representing O.J. Simpson in his 1995 trial, and for being the father of Kim, Khloe, Rob and Kourtney who are on the television series Keeping Up with the Kardashians. Mr. Kardashian was diagnosed with esophageal cancer in July 2003 and died just two months later, at age 59.

Kim Kardashian West and her mother, Kris Jenner, along with other family members, attended the ribbon-cutting ceremony honoring her late father. After the event, Kim tweeted, “So proud to announce the Robert G Kardashian center for esophageal health being launched at UCLA. My wish is that other families can have more information and we can also focus on health and prevention.”

What is Esophageal Cancer?

Esophageal cancer begins when cells in the esophagus mutate and divide abnormally. This cancer is the sixth-leading cause of cancer death in the world because it is fast-growing, aggressive and has few symptoms.

Incidence of esophageal cancer and esophagus disorders has increased dramatically in the past decade. Risk factors include alcohol and tobacco use, obesity, poor nutrition and gastroesophageal reflux disease (GERD). Chronic acid reflux damages the lining of the esophagus and can cause a condition called dysplasia, which increases the risk for Barrett’ esophagus, a precursor to esophageal cancer.

How to Lower Your Risk for Esophageal Cancer

You can take proactive steps to lower your risk for esophageal cancer by adopting healthy lifestyle habits.

1. Eat a well-balanced diet with lots of fruits, vegetables, whole grains, lean proteins and healthy fats.
2. Limit your alcohol intake and drink only on special occasions.
3. Quit smoking and do not use tobacco products.
4. Visit your doctor annually for well visits.
5. Say “yes” to all preventive screenings. Preventing disease is always more cost-effective than treating it.
6. Call your doctor if you notice symptoms of an esophageal disorder which include heartburn, difficulty swallowing, indigestion, chest pain, persistent coughing, hoarseness, throat burning or weight loss.

Men’s Health Week is celebrated during the week that ends on Father’s Day each year. Men’s Health Week is an opportunity for men and boys to learn more about how they can commit to wellness.