Jeffrey Linder

Who they are

Linder holds an MD from Northwestern University, awarded in 1997, and a Master of Public Health from the Harvard T.H. Chan School of Public Health. He trained in residency at the University of California, San Francisco, and completed a fellowship at Massachusetts General Hospital. For about fourteen years he worked at Harvard Medical School and Brigham and Women's Hospital in Boston as a general internist and primary care clinician-investigator, where he directed the hospital's Primary Care Practice Based Research Network. In 2016 he joined Northwestern as chief of General Internal Medicine and Geriatrics in the Department of Medicine.

His research programme, as Northwestern describes it, concerns outpatient antibiotic use and the care of ambulatory patients with acute respiratory infections, with the aim of improving primary care.

Key papers

Linder, J. A., Doctor, J. N., Friedberg, M. W., Reyes Nieva, H., Birks, C., Meeker, D., & Fox, C. R. (2014). Time of day and the decision to prescribe antibiotics. JAMA Internal Medicine, 174(12), 2029-2031. doi:10.1001/jamainternmed.2014.5225

The paper analysed 21,867 visits for acute respiratory infection by 204 clinicians in 23 primary care practices in a Boston-area health system, between May 2011 and September 2012. It compared antibiotic prescribing across two four-hour weekday sessions, using clinician fixed effects.

Key ideas

The 2014 paper reports that the odds of an antibiotic prescription rose across a session: about a quarter higher in the fourth hour than in the first, with the second hour close to the first. The authors describe time within the session as a proxy for decision fatigue and list limits themselves: a single health care system, scheduled visit time standing in for actual visit time, and the possibility of unmeasured confounding. They note that other accumulating factors, such as general fatigue, could contribute to the pattern.

This site uses the paper as one of three field records in its account of decision fatigue, alongside a study of parole rulings and a study of analyst forecasts. All three are observational, and none separates a depleted resource from scheduling effects or from a choice to spend less effort.

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