| Let me show you how I know. Not with my opinion, but with a study that did the one thing nobody thinks to do: it sorted the visits by the hour on the clock. |
| A team at the University of Pennsylvania pulled the records of thirty-three primary care practices. They found every patient who was due for a screening under the national guidelines, and for breast cancer screening that came to 19,254 women. Then they lined the visits up by appointment time, from the eight o’clock hour through the five o’clock hour. |
| They measured two things. One was whether the doctor placed the order during the visit at all. The other was whether the woman had the mammogram within the next year. |
| What they found |
| Penn Medicine, 2019. Hsiang et al., JAMA Network Open. |
| The five o’clock hour (17.8 percent screened) |
| At five in the afternoon the order was placed in 47.8 percent of those visits. A year later, 17.8 percent of the women had been screened. |
| The eight o’clock hour (33.2 percent screened) |
| At eight in the morning the order was placed in 63.7 percent of visits, and within a year 33.2 percent had been screened. Same practices, same guidelines, same patients on the schedule. |
| Later appointment times were linked to lower ordering and lower completion, hour by hour, with a small rise right after lunch. |
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| In other words, two women the same age, with the same risk and the same doctor, may leave with different outcomes, and the thing separating them was what time the scheduler had an opening. |
| Marguerite’s memory had nothing to do with it. Yours does not either, I would bet. |
| So why would the clock change what a doctor orders? |
| The researchers point to two things, and neither one is about the patient. A doctor in primary care makes hundreds of small calls in a day, each screening conversation costs a few minutes she does not have, and by late afternoon the decision that takes the least effort is the one to leave it until next time. The schedule does the rest. A fifteen minute slot that started forty minutes late has to give something up, and what it gives up is the part of the visit nobody is complaining about yet. That is why the ordering rate went back up at noon: the lunch hour gave them room to catch up. |
| Marguerite never stood a chance at 4:40 in the afternoon. Neither did the woman before her, I would bet, or the one after. |
| That’s the part no one says out loud… every October the flyers go up and the message is the same, which is that it falls to her to schedule it, ask for it and speak up for herself. Nobody hands her the one piece of information the study actually produced. |
