好的醫(yī)療護(hù)理可能會(huì)在一天的晚些時(shí)候受到影響

好的醫(yī)療護(hù)理可能會(huì)在一天的晚些時(shí)候受到影響

A young woman came to my clinic on recent evening to discuss her irregular menstrual periods. She had scheduled the appointment weeks in advance, and we were slated to have 20 minutes together.

最近晚上，一名年輕女子來(lái)到我的診所，討論她的月經(jīng)不調(diào)問(wèn)題。她提前幾周安排了約會(huì)，我們本來(lái)計(jì)劃在一起呆20分鐘。

I'm a family physician in a busy urban practice, and when she walked in I'd already been seeing patients for 10 hours that day, with a new one showing up about every 20 minutes. I'm exhausted.

我是一名家庭醫(yī)生，在一個(gè)繁忙的城市診所工作，當(dāng)她走進(jìn)來(lái)的時(shí)候，我那天已經(jīng)看了10個(gè)小時(shí)的病人，每20分鐘就有一個(gè)新病人出現(xiàn)。我已經(jīng)身心疲憊。

Even as I spoke to this patient, my mind darted, as it's been trained to do, to several different possible causes of her symptoms, ranging from a harmless side effect of a medication to a brain tumor. I started tallying a list of the tests we'd need to order.

就在我跟這個(gè)病人說(shuō)話的時(shí)候，我的思緒就像往常一樣，飛快地轉(zhuǎn)到她癥狀的幾個(gè)不同的可能原因上，從藥物的無(wú)害副作用到腦瘤。我開(kāi)始統(tǒng)計(jì)我們需要訂購(gòu)的化驗(yàn)單。

Then, a notification aimed at me popped up in her electronic medical record: She was due for a flu shot. As I typed up her instructions about the further tests and handed her a specimen cup to get a urine sample, I also encouraged her to let us give her a flu shot before she left the office, to "just get it done."

然后，她的電子病歷里突然出現(xiàn)了一條針對(duì)我的通知:她要打流感疫苗了。當(dāng)我把她關(guān)于進(jìn)一步檢查的說(shuō)明打印出來(lái)，遞給她一個(gè)尿樣杯，讓她取尿樣的時(shí)候，我還鼓勵(lì)她在離開(kāi)辦公室之前讓我們給她打一針流感疫苗，讓她“做完就好”。

She wasn't in the mood to get stuck with a needle, she told me, and declined. I wanted to talk more about the shot, but she stopped me. "Not tonight, Dr. Gordon," she said.

她告訴我，她沒(méi)有心情被針扎住，于是謝絕了。我想多談?wù)劥蜥樀氖?，但她阻止了我?ldquo;今晚不行，戈登醫(yī)生，”她說(shuō)。

It was late. She wanted to get home to her family, and frankly, so did I. Our office was supposed to have closed 30 minutes earlier. So I let it go, and she missed out on a vaccine that would have helped her stay healthy.

已經(jīng)很晚了。她想回家和家人團(tuán)聚，坦率地說(shuō)，我也是。我們的辦公室本應(yīng)該提前30分鐘關(guān)門(mén)。所以我放棄了，她錯(cuò)過(guò)了一種可以幫助她保持健康的疫苗。

It turns out I'm not alone in finding the end of my workday as a primary care physician more challenging than the beginning. According to a growing body of research, going to the doctor late in the day may mean you get lower-quality care.

事實(shí)證明，我并不是唯一一個(gè)發(fā)現(xiàn)作為一名初級(jí)保健醫(yī)生的工作日結(jié)束時(shí)比開(kāi)始時(shí)更具挑戰(zhàn)性的人。根據(jù)越來(lái)越多的研究，一天中晚些時(shí)候去看醫(yī)生可能意味著你得到的醫(yī)療質(zhì)量較低。

A study last summer in the journal JAMA Network Open, for example, found that people who saw their doctor for acute pain later in the workday were more likely than those with morning appointments to get a prescription for opioid painkillers — a class of medications with potentially life-threatening side effects.

例如，去年夏天發(fā)表在《美國(guó)醫(yī)學(xué)會(huì)網(wǎng)絡(luò)開(kāi)放》雜志上的一項(xiàng)研究發(fā)現(xiàn)，工作日晚些時(shí)候因急性疼痛去看醫(yī)生的人，比那些早上有預(yù)約的人更有可能拿到阿片類止痛藥的處方，這是一類具有潛在生命威脅副作用的藥物。

Another recent study suggests that patients seen later in the day are less likely to receive recommended cancer screening tests, like mammograms.

最近的另一項(xiàng)研究表明，晚些時(shí)候就診的患者接受建議的癌癥篩查(如乳房x光檢查)的可能性較小。

What's going on?

到底怎么回事?

The reasons behind the trend aren't clear from those studies, but I can attest that the end of my day in clinic is often more chaotic than the beginning. My patients are eager to get home. When a patient comes in at 5:00 p.m. to deal with a cough, the last thing she wants is to stay until 5:30 talking about mammograms.

這些研究不清楚這一趨勢(shì)背后的原因，但我可以證明，我在診所的一天結(jié)束時(shí)往往比開(kāi)始時(shí)更混亂。我的病人急切地想回家。當(dāng)病人下午5點(diǎn)來(lái)的時(shí)候。為了治療咳嗽，她最不想做的事就是一直呆到5點(diǎn)半，談?wù)撊榉縓光檢查。

Those sorts of factors make late-in-the-day appointments feel more rushed than early ones, researchers say, and that can put patients' health at risk.

研究人員說(shuō)，這些因素使當(dāng)天晚些時(shí)候的預(yù)約比早些時(shí)候的預(yù)約更匆忙，這可能會(huì)危及患者的健康。