The Short Answer: By the end of clinic, patients are 33 percentage points less likely to be offered surgery than those seen first. The cause is decision fatigue — the progressive depletion of cognitive resources through repeated decisions. Theatre culture, including adequate rest, structured breaks, and comfortable attire, helps counteract this invisible threat to clinical judgement.

Decision Fatigue in the Clinic

Persson and colleagues studied orthopaedic surgeon decision-making and found that the odds of scheduling an operation fell by 10.5% with each additional patient seen during a shift. By the end of clinic, patients were 33 percentage points less likely to be offered surgery than those seen first thing.

The difference was not clinical. It was cognitive. Decision fatigue, the progressive depletion of mental resources through repeated decision-making, quietly shifts behaviour towards the path of least resistance.

How It Works

Every decision draws from the same cognitive well. After hours of weighing surgical indications, reviewing imaging, and discussing risks with patients, the brain gravitates towards the easiest option. In surgery, that almost always means “conservative management.” Not because it is clinically superior, but because it requires fewer downstream decisions.

The pattern mirrors the well-known study of Israeli parole judges, where approval rates dropped from 65% to nearly zero before lunch, then reset after a food break. The mechanism is universal. Human decision quality degrades over time without recovery.

An Invisible Threat

Decision fatigue does not announce itself. Surgeons do not feel themselves becoming less decisive. There is no warning sign, no internal alarm. The surgeon at 4pm feels much the same as the surgeon at 9am. The data says otherwise.

This is precisely why theatre culture matters. Scheduled breaks, checklists that compensate for cognitive drift, team structures that distribute the decision load. All of these counteract the silent erosion of judgement that accumulates across a long shift.

Every Advantage Counts

When decision fatigue is the constant background threat, everything that supports sustained cognitive performance matters. Adequate rest. Proper hydration. Thermal comfort. And yes, attire that supports rather than hinders concentration.

A well-designed scrub cap that breathes and fits comfortably is not a vanity item. It is one less source of physical distraction during a long day of high-stakes decisions.