First things first

Not first available. First available in the morning.

We’re in low power mode through the holidays. But since we’re about to hit the biggest “turn over a new leaf and tackle new health habits” day of the year, I thought I’d share an easy one from the archives.

What percentage of the Internet do you suppose is devoted to people telling you that if you can be richer, healthier or happier, if only you'll change "one easy thing" in your life?

Most often, the supposedly "easy thing" turns out to be darn near impossible, or at least impractical: Just lose 30 pounds, or become vegan, or skip your morning coffee to make an extra monthly mortgage payment. 

Sure, okay.

This is why I nearly laughed when I finally came across a scientific study, approved by the University of Pennsylvania institutional review board, that legitimately suggests a single thing you can do to improve your health outlook and possibly live longer.

It's not particularly sexy, but it makes sense, and it has to do simply with the time of day that you make appointments with health care providers.

52,722 patients

Writing in JAMA Network Open, the authors examined doctor visits involving a total of 52,722 patients, whom they calculated should have been eligible for either breast cancer or colorectal cancer screenings. 

They found a significant discrepancy in whether the patients were actually referred for screenings, based on the time of day that they had their medical appointments.

For example, among the 19,254 women patients who should have been eligible for breast cancer screenings, the researchers found :

• 8 a.m. appointments led to a 63.7 percent screening rate;

• 11 a.m. appointments led to a 48.7 percent screening rate;

• 12 p.m. appointments had a 56.2 percent screening rate; and

• 5 p.m. appointments had a 47.8 percent screening rate.

The same pattern held true for the 33,468 patients who should have been eligible for colorectal cancer screenings:

• 8 a.m. appointments led to a 35.5 percent screening rate;

• 11 a.m. appointments led to a 31.3 percent screening rate;

• 12 p.m. appointments increased slightly to a 34.4 percent screening rate; and

• 5 p.m. appointments led to just a 23.4 percent screening rate.

Early detection is vital

Cancer screenings aren't necessarily pleasant, but they are necessary. And while breast cancer and colorectal cancer can be fatal, they’re also highly survivable cancers, if they're detected early enough.

And if doctors are less likely to order the screenings if you see them later in the day, the easiest thing to do is obviously to seek earlier appointments.

It's not just about cancer, either.

In a previous study these same researchers say they found that as the day went by, the percent of patients that doctors encouraged to be vaccinated against influenza dropped from about 44 percent in the morning to 32 percent at the end of the day.

Moreover: "evidence indicates that later in the day, there are higher rates of inappropriate antibiotic prescriptions by [primary care physicians], higher rates of opioid prescribing for back pain ... and lower rates of appropriate hand-washing among clinicians during the end of hospital shifts."

Don't blame the doctors

The study was “pre-pandemic,” but writing about it in the New York Times, Jeffrey A. Linder, a professor of medicine at Northwestern, said the real problem is that a primary care physician's workload is technically impossible to handle correctly without stretching the workday to between 11 and 18 hours.

We spend one to two hours updating the electronic health record for every hour we spend with patients. To try to fit in what we can, we end up feeling like Lewis Carroll's White Rabbit, constantly behind, checking our watches, harried, rushing from patient to patient.

So, what's the solution? Well, instead of asking for "first available," as I'm prone to do, ask for "first available, first thing in the morning."

And since by definition we can't all have the first appointment of the day, Linder has some other advice:

Prepare. Learn about screenings you might be eligible for, work with your doctor to figure out which are right for you. Once screening or follow-up tests are ordered, make the necessary follow-up arrangements right away. And consider having [a] cup of coffee before your visit. 

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Thanks for reading. I hope you have a wonderful holiday break. Photo by Martha Dominguez de Gouveia on Unsplash. I wrote about some of this before at Inc.com. Hope you’re having a wonderful break; see you in the comments.