There is no arguing that clinical decision making is a very complex process; it is driven by quite a few different factors, from social, to psychological, peer pressure, drug advertising, etc. As it turns out, however, at least according to an in-depth study performed by Harvard Medical School, a physician’s habit might, in fact, determine their choice of insomnia medication.

What the Study Showed

The idea here is that physicians choose a medication based on routine rather than choosing one based on the patient’s symptoms and medical history. While this might not inherently cause any harm to the patient, it may mean that the patient in question does not see 100% positive results and their condition may not be completely treated. If one were to study the past patterns of these physicians, they would definitely stick to their guns, so to speak, and when the choice of medication usually falls to the physician’s preference rather than the patient, this can create a potential problem.

Casting a Wide Net

This study was conducted through the examination of 1,105 patient medical records along with the attached clinical notes. The study appeared in the February 9^th issue of Scientific Reports, and it really showed that physicians are not above the general execution of what we refer to as ‘human behavior’. Physicians are ‘creatures of habit’, and this general prescribing of medications is not necessarily intentional malice on their part, even if the medication in question does not get the results that we would prefer. It may, in fact, be that physicians rely on what we would call cognitive shortcuts, and are simply not as rational as we tend to believe. This is a difficult concept for many to grasp because we quite literally trust physicians with our lives whether we’re undergoing sleep apnea testing or getting that much-needed medication for insomnia.

A Correctable Situation

This is not a situation that is impossible to correct. Just as with any other condition out there, the doctor needs to pay close attention to his or her actions and choose the optimal medication based on the symptoms, rather than going with ‘instinct’. In the end, physicians must be held to the same high standard that they were held to while they were in medical school.

Critical Analysis

Within the confines of the study, the analysis pointed to the fact that the two most commonly prescribed drugs in the insomnia arena have been zolpidem and trazodone. These are on two radically opposite ends of the spectrum as the former is a newer medication and the latter is much older. It is known that while zolpidem garners better results, it is not necessarily a great choice because it harbors some pretty nasty side effects such as drowsiness and dizziness. Trazodone, on the other hand, is much safer, but the big question, is why do physicians choose these drugs over any other, and why are they going with one over the other?

The study continued by analyzing patient records, and it was found that a doctor who had prescribed one medication previously, would, in fact, be three times as likely to continue prescribing it in the future. Another common factor seemed to be depression, and patients who suffered from it along with insomnia would often end up with trazodone following sleep apnea testing. This revelation points to the possibility that patient conditions and characteristics may, in fact, play a small role in physician medication choice.

Conclusion

In the end, despite all of the technology at our disposal including extensive at-home sleep apnea test results, physicians are still creatures of habit, and it is critical that they pay close attention to these habits to ensure that they are giving the patient the best treatment possible. There is still going to be room (always) for instinct and intuition when it comes to patient care. In fact, this is often the deciding factor in life or death situations, but sometimes, physicians do need to break out of their stagnant routines and make sure that they’re administering the proper treatment.