Pain management is one of the biggest challenges of the modern health system. About 60% of American adults have experienced pain in the past three months and pain is one of the main reasons adults seek medical care. Adequate pain management is vital to the health and well being of the patient. A new study published today in Proceedings of the National Academy of Science ,PNAS), found that physicians prescribed less pain medication on the night shift than during the day.
The research was supported by Dr Anat Perry from the Hebrew University of Jerusalem (HU) School of Business Administration and the Federman Center for the Study of Rationality, HU Psychology Department, and Dr. Alex Gilles-Hillel from Hadassah Medical Center and HU.
In the first part of the study, 67 doctors were given a morning empathy assessment task and asked to respond to simulated patient scenarios. These doctors were either at the end of a 26-hour shift or just beginning their workdays. The study found that doctors who had recently completed night shifts showed less empathy for a patient’s pain. For example, these physicians demonstrated a reduction in emotional responses to photographs of people in pain and consistently scored their patients low on pain assessment charts.
In the second part of the study, researchers looked at actual medical decisions made by emergency room doctors in the United States and Israel. In all, they analyzed 13,482 discharge letters for patients who came to the hospital with the main complaint of pain (headache, back pain, etc.) in 2013-2020. In all data sets, physicians were 20–30% less likely to prescribe an analgesic during the night shift (compared to the day shift) and prescribed fewer painkillers than is generally recommended by the World Health Organization . “They are tired and so they are less sympathetic to patients’ pain. When we looked at ER doctors’ discharge papers, we found that they prescribed fewer painkillers,” explained Choshen-Hill.
This bias remained significant even after adjusting for patients’ pain levels, patient and physician demographics, type of complaint, and emergency department characteristics. “Our conclusion is that nightshift work is an important and previously unrecognized source of bias in pain management, which likely stems from poor perception of pain. When we try to provide the best care for patients, they are susceptible to the effects of a nightshift,” Perry said.
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’ work schedules. “Our findings may have implications for other workplaces that involve shiftwork and empathetic decision-making, including crisis centers, first responders, and the military. Indeed, these results probably matter for all people who are sleep-deprived,” Giles said- Hillel.
In addition to the three lead authors, Israeli authors included Tom Gordon-Hecker, Shir Genzer and Salomon Israel from the Hebrew University and Ido Sadras and David Rechtman of the Hadassah-Hebrew University Medical Center in Jerusalem. The US research team included David Gozel, Coby Clements and Adrienne Ohler from the University of Missouri, and Eugene M. Caruso from UCLA.
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