I read the recent work of Graffelman et al1 and a letter by Damoiseaux2 with great interest. They discuss community antibiotic use, with options for reducing prescribing safely.
Are primary care clinicians susceptible to altered prescribing because of attitudes on certain days of the week? This consideration emerged after discussion with colleagues; the conclusion being Friday afternoons would be the period for low-threshold prescribing. Reasons behind this include the fact that patients seen on Fridays have the weekend to potentially become even more unwell;3 making it appropriate to prescribe before the weekend. There is also the idea that some physicians prescribe on Fridays so their patients will not make use of other doctors or walk-in centres over the weekend.4
Another reason given interested me greatly: would doctors give less thought and prescribe more simply because it was Friday? After all, not giving antibiotics involves a greater investment of physician time.5 The temptation is there: even as a pre-registration house officer, I have felt frustration when patients arrive late at the end of a week. Would this and the fact that it's Friday affect our prescribing?
During my time at Selsdon Park Medical Practice (a five-partner surgery in South London) Egton Medical Information Systems (EMIS) searches that were performed achieved numbers of patients seen per day, then detected how many of these were prescribed antibiotics.
From 4 January–24 April 2004, the practice saw 12 144 patients with 20 342 total entries. Thus, on average, a patient has 1.675 complaints. Antibiotic prescriptions totalled 1533. Averaged results for prescribing rates of each day are:
Of note, is that Friday results show no difference compared with those from Tuesdays, Wednesdays, or Thursdays. Analysing the variance between average rates for individual days over this period shows a significant difference (P = 0.0003) between each group of averaged days, with Monday being significantly higher.
An explanation for this is perhaps that patients have brewed illnesses over the weekend — due to the comparative decrease in doctors over this time, plus the concept of ‘waiting to see how I feel’, resulting in a potential worsening of symptoms.
The interest lies in the fact that Friday prescribing rates are no different to the remaining days of the week. Does that mean we do not let ‘Friday afternoon moods’ affect us, even though we are aware of them?
- © British Journal of General Practice, 2004.
