Physicians prescribe less analgesic medication during nightshifts than during the day, according to a new study published in PNAS.
In the first part of the study, 67 doctors were given empathy assessment tasks in the morning and asked to respond to simulated patient scenarios. These doctors were either at the end of a 26-hour shift or just beginning their workday. The study found that doctors who recently completed night shift showed less empathy for patient’s pain. For example, these physicians’ exhibited decreased emotional responses to pictures of people in pain and consistently scored their patients low on pain assessment charts.
In the second part of the study, the researchers looked at actual medical decisions made by emergency room doctors in the United States and Israel. Analysed 13 482 discharge letters for patients who came to the hospital in 2013–2020 with a chief complaint of pain, they found that physicians were 20–30% less likely to prescribe an analgesic during nightshifts (compared to daytime shifts) and in amounts less than generally recommended by the World Health Organization. “They’re tired and therefore they’re less empathic to patients’ pain. When we looked at ER doctors’ discharge papers, we found that they prescribed fewer painkillers,” explained Professor Shoham Choshen-Hillel from the Hebrew University of Jerusalem (HU)’s School of Business Administration and Federmann Center for the Study of Rationality, who led the study.
The bias persisted after adjusting for patients’ reported level of pain, patient and physician’s demographics, type of complaint, and emergency department characteristics. “Our takeaway is that nightshift work is an important and previously unrecognised source of bias in pain management, likely stemming from impaired perception of pain. The researchers explain that even medical experts, who strive to provide the best care for their patients, are susceptible to the effects of a nightshift,” noted co-lead author HU Psychology Department’s Dr Anat Perry.
Looking ahead, the researchers suggest implementing more structured pain management guidelines in hospitals. Another important implication relates to physician work structure, and the need to improve physicians’ working schedules. “Our findings may have implications for other workplaces that involve shiftwork and empathic decision-making, including crisis centres, first responders, and the military. In fact, these results should probably matter to all people who are sleep-deprived,” added co-lead author Dr Alex Gileles-Hillel from Hadassah Medical Center and HU.