Doctors less likely to prescribe painkillers during night-shifts than during the day: Study

According to a new research, physicians were 20 to 30% less likely to prescribe an analgesic during nightshifts (relative to dayshifts) and prescribed less medicines than the World Health Organization recommended.

A multidisciplinary team led by Professor Shoham Choshen-Hillel from the Hebrew University of Jerusalem’s School of Business Administration and Federmann Center for the Study of Rationality, Dr. Anat Perry from the HU Psychology Department, and Dr. Alex Gileles-Hillel from Hadassah Medical Center and HU conducted the research. 67 clinicians were given empathy assessment tasks in the morning and asked to respond to simulated patient scenarios in the first portion of the study.

These doctors were either at the conclusion of a 26-hour shift or just getting started. The study discovered that doctors who had just finished a night shift had less empathy for their patients’ misery. These doctors, for example, showed lower emotional reactions to images of individuals in agony and regularly ranked their patients low on pain assessment charts.

The researchers looked at real medical judgments made by emergency department doctors in the United States and Israel in the second portion of the study.

In all, they analyzed 13,482 discharge letters for patients who came to the hospital in 2013-2020 with a chief complaint of pain (headache, back pain, etc.). Across all data sets, physicians were 20-30% less likely to prescribe an analgesic during nightshifts (compared to daytime shifts) and prescribed fewer painkillers than were 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,” Choshen-Hillel explained.

This bias remained significant even 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 unrecognized 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,” Perry noted.

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 centers, first responders, and the military. In fact, these results should probably matter to all people who are sleep-deprived,” added Gileles-Hillel.

In addition to the three lead authors, the Israeli authors included Tom Gordon-Hecker, Shir Genzer and Salomon Israel from the Hebrew University and Ido Sadras and David Rekhtman the Hadassah-Hebrew University Medical Center in Jerusalem. The US research team included David Gozal, Koby Clements, and Adrienne Ohler from the University of Missouri, and Eugene M. Caruso from UCLA.