Physicians found to prescribe less pain medication during the night than the day
Working the night shift appears to make doctors less sympathetic to patients’ pain.
That conclusion emerges from a newly-published study of patterns of pain medication prescribing among American and Israeli emergency department (ED) doctors. It found that doctors prescribed less pain medication during nightshifts than during the day. The findings were published June 27 in The Proceedings of the National Academy of Sciences (PNAS).
The study consisted of two parts. In the first part, 67 ED physicians performed empathy assessment tasks and responded to simulated patient scenarios in the morning. The physicians either had just finished a 26-hour shift or were about to start their workday. The doctors who had recently finished a night shift consistently scored their patients low on pain assessment charts and showed decreased emotional response to pictures of people in pain.
In the second part, the authors analyzed more than 13,000 discharge letters from American and Israeli ED doctors for patients who came to the hospital in the period 2013-2020 with a chief complaint of pain, such as headache or back pain. They found that across all data sets, physicians were 20% to 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.
The 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,” Anat Perry, Ph.D., senior lecturer in the psychology department at Hebrew University of Jerusalem said in an accompanying news release.
“Even medical experts, who strive to provide the best care for their patients, are susceptible to the effects of a nightshift,” Perry added.
The authors suggest addressing the problem by implementing more structured pain management guidelines in hospitals and changing physicians’ work schedules.