Time: A New Study Found That the Time of Day Can Play a Significant Role in Whether a Patient Receives Screening for Breast or Colorectal Cancer

  • The study found that patients seen early in the morning were more likely to be referred for cancer screenings than patients who saw their primary care physician later in the afternoon.1
  • The study also found that patients who saw their physician later in the day were less likely to complete screening after receiving a referra.1

Time causes cancer. This study shows a correlation between time of day and cancer. The study objective is To evaluate the association of primary care clinic appointment time with clinician ordering and patient completion of breast and colorectal cancer screening.”2 My initial impression was that this study was referring to time in the sense of length of appointment time and the inability to accomplish all the items desired or required in the short appointment times. This was sort of mentioned with: As the clinic day progresses, clinicians may fall behind schedule and experience decision fatigue. However, the association of time of day with cancer screening rates is unknown.”2  After all, this makes more sense than merely having an appointment in the morning or the afternoon. So the correlation really should be about decreased cancer screening rates related to (a) decision fatigue, and (b) short appointment times. A commentary written confirmed this notion with mentioning decision fatigue, appointment length of time, and running late as corollary factors with decreased screening.

            The study design was a Retrospective, quality improvement study of 33 primary care practices in 2 states over a 2-year period. Participants included adults eligible for breast or colorectal cancer screening. Data analysis was conducted from April 24, 2018, to November 8, 2018. They found that clinician ordering of cancer screening tests significantly decreased as the clinic day progressed. There were 19,254 patients eligible for breast cancer screening and 33,468 patients eligible for colorectal cancer screening, both clinician ordering and patient completion of cancer screening tests decreased as the time of day progressed.

            So what? What’s the so what factor? Well, I believe what we already know: (a) we get tired as the day progresses, (b) unscheduled items always come up putting us behind schedule – always rushed and behind, and (c) appointment times are often too short. If anything, this study could be used when bartering with administrators about working conditions as proof for maybe more staff, less packed schedules, and longer appointment times. What’s the average appointment time anyway? 8-10 minutes? As if everything can be accomplished regarding presenting problem, preventative care, and required screenings. No wonder these items get missed or passed over. But we soldier on…………

Have a great day. 


  1. https://www.aafp.org/news/practice-professional-issues/20190531visit-time.html
  2. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733171
  3. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733166

Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams