好的医疗护理可能会在一天的晚些时候受到影响

好的医疗护理可能会在一天的晚些时候受到影响

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，一名年轻女子来到我的诊所，讨论她的月经不调问题。她提前几周安排了约会，我们本来计划在一起呆20分钟。

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.

我是一名家庭医生，在一个繁忙的城市诊所工作，当她走进来的时候，我那天已经看了10个小时的病人，每20分钟就有一个新病人出现。我已经身心疲惫。

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.

就在我跟这个病人说话的时候，我的思绪就像往常一样，飞快地转到她症状的几个不同的可能原因上，从药物的无害副作用到脑瘤。我开始统计我们需要订购的化验单。

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，她的电子病历里突然出现了一条针对我的通知:她要打流感疫苗了。当我把她关于进一步检查的说明打印出来，递给她一个尿样杯，让她取尿样的时候，我还鼓励她在离开办公室之前让我们给她打一针流感疫苗，让她“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.

她告诉我，她没有心情被针扎住，于是谢绝了。我想多谈谈打针的事，但她阻止了我。“今晚不行，戈登医生，”她说。

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.

已经很晚了。她想回家和家人团聚，坦率地说，我也是。我们的办公室本应该提前30分钟关门。所以我放弃了，她错过了一种可以帮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.

事实证明，我并不是唯一一个发现作为一名初级保健医生的工作日结束时比开始时更具挑战性的人。根据越来越多的研究，一天中晚些时候去看医生可能意味着你得到的医疗质量较低。

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，去年夏天发表在《美国医学会网络开放》杂志上的一项研究发现，工作日晚些时候因急性疼痛去看医生的人，比那些早上有预约的人更有可能拿到阿片类止痛药的处方，这是一类具有潜在生命威胁副作用的药物。

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

最近的另一项研究表明，晚些时候就诊的患者接受建议的癌症筛查(如乳房x光检查)的可能性较小。

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.

这些研究不清楚这一趋势背后的原因，但我可以证明，我在诊所的一天结束时往往比开始时更混乱。我的病人急切地想回家。当病人下午5点来的时候。为了治疗咳嗽，她最不想做的事就是一直呆到5点半，谈论乳房X光检查。

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.

研究人员说，这些因素使当天晚些时候的预约比早些时候的预约更匆忙，这可能会危及患者的健康。