Researchers have identified the “Monday blues” as one of the reasons why patients miss medical appointments.”
There is an English pop song with the line, “January, sick and tired you’ve been hanging on me…” January is just not a popular month in England! The days are dark, the weather is cold and wet and we have just finished the wonderful feasting, sharing and celebration of Christmas and the start of the New Year. January seems to be just a thump back to ‘reality’, having to face all those more difficult problems that we had put off and tried to forget about whilst we celebrated.
There is interesting research looking at the feelings of patients on certain days of the week, and how feelings vary from Monday when they feel relatively low and apathetic, to Friday when they feel brighter and more hopeful. The research also shows that patients remember Mondays and Fridays better but that Tuesdays, Wednesdays and Thursdays go into a bit of a blur – and that they are most likely to think it was always Thursday! 1
Dr Rob Jenkins writes: “Recent psychological studies have shown that different days of the week evoke distinct emotional responses. Mondays have the most negative response; Fridays the most positive. A person’s emotional tone brightens steadily over the intervening days.
“Missed appointments seem to follow the psychological peaks and troughs of the weekly cycle, with emotionally positive days boosting patient resilience and improving attendance.
“This interpretation chimes with many of the psychological reasons patients give for missing their appointments: fear of bad news; fear of unpleasant treatment; or even negative relationships with medical staff.” 2
The study indicates that there was a clear trend for patients being more likely to turn up at a surgery or hospital towards the end of the week. Consequently, the team from Glasgow University has recommended moving more appointments to Thursdays and Fridays.
The study is interesting as it links concern about how the patient feels with the expense of running the health service.
“An absolute reduction in non-attendance rate of just 1.2% could save the British Health Service sixty million British pounds per year. Improving attendance would also reduce health risk to patients.”
The interesting observation is this one small change could affect large numbers of patients and healthcare professionals, as well as resulting in a huge financial saving.
There are of course many reasons why patients do not attend their medical appointments, but a number of studies have shown that the people who do not attend are those who have the poorest health outcomes – and therefore most need to be seen.
What it also shows is how little the health service in the UK works to help patients use the service and attend their appointments to the benefit of their physical, emotional and spiritual health. Have you ever reflected whether you spend more time keeping the patient and their family away from you or your service than you do actually arranging to see and care for the patient?
There is an overriding feeling amongst doctors and nurses that patients want to and demand to see medical staff unnecessarily. However, this research demonstrates that people can be quite fearful of what might happen when they come to see a doctor or nurse. They do not want to hear about their illness and disease and they are fearful of what the relationship with the healthcare professional might be like. They worry how they may feel after the interview, how they will feel about cooperating with invasive tests and treatments that are suggested to them.
The paper quoted reflects attendance rates for hospital and GP appointments and suggests a small alteration towards patient preference for more appointments nearer the end of the week and fewer at the beginning. So the question is: ”Is your medical service run for the convenience of the doctors’ and nurses’ and healthcare workers’ working week and feelings, or is it run for the health and emotional resilience of the patient and their families?”
If a simple alteration to appointment times offered by surgeries and hospitals could save tens of millions of pounds in missed appointments, the alteration to running your whole service for the best outcome for the patient, physically, emotionally and spiritually would create a revolution in medicine – both for health and financial outcomes.
So here’s a challenge for the New Year in your work as a healthcare professional:
Can you spend a week working as a doctor or nurse in your health service considering with every patient how they might be feeling about their interaction with you? Can you voice with them what their fears are about the way they will be treated? Can you explore with them what their understanding of the disease and its natural history is, and help them rationalise their fears of the unknown?
Dr Ros Simpson
(Senior PRIME tutor)
1. Ellis DA, Jenkins R (2011) I keep thinking it’s Thursday: Cognitive confusions over the day of the week. Paper presented at Experimental Psychology Society, July 6–8, 2011, Nottingham, UK.
2. Weekday affects attendance rate for medical appointments: Large-scale data analysis and implications, by David Ellis and Rob Jenkins (School of Psychology, University of Glasgow) is published in the online journal PLoS One. http://dx.plos.org/10.1371/journal.pone.0051365