Night Shift Changes How Doctors Give Pain Relief

According to a recent study, doctors are less likely to administer painkillers towards the end of a long night shift than they are at the beginning. This finding may indicate that doctors have less empathy for patient pain when they are feeling exhausted themselves.

The study's authors are urging hospitals to take more measures to control the work schedule and workload of medical personnel in order to prevent clinical judgments from being adversely impacted by exhaustion in this manner.

The researchers propose that even simply educating physicians about potential bias at the conclusion of their shift might be beneficial. Making sure patients receive the care they require may also benefit from more stringent regulations for the prescription of painkillers.

"Our takeaway is that night shift work is an important and previously unrecognized source of bias in pain management, likely stemming from impaired perception of pain," according to Israeli psychologist Anat Perry from the Hebrew University of Jerusalem.

"Even medical experts, who strive to provide the best care for their patients, are susceptible to the effects of a night shift."

Israel's 31 newly hired resident doctors and 36 physicians who had recently finished a 26-hour shift each participated in the study. Invented situations with a female patient with a headache and a man patient with back pain were offered to these individuals.
In these fictitious situations, doctors who were ending their shift judged the patients' pain as being less severe and were less inclined to provide them painkiller prescriptions to treat their discomfort. The degree of another person's suffering and, consequently, the type of care they require, appear to be determined in part by their level of exhaustion.

The study also examined 13,482 discharge letters for patients from the US and Israel that were gathered over a seven-year period. In all the data sets, doctors were 20–30% less likely to recommend painkillers during the night shift.

"The fact that the divergence of analgesic prescription from the general World Health Organization guidelines is greater during night shifts suggests that there is indeed an under-prescription during night shifts, rather than an over-prescription during daytime," according to pediatric pulmonologist David Gozal of the University of Missouri School of Medicine.

The study's authors note that the bias persisted even after adjusting for the severity of the reported pain, the demographics of the patients and the doctors, the nature of the complaint, and differences between emergency rooms.

It's crucial to ensure that pain is appropriately handled and avoided whenever possible because it's one of the primary reasons individuals visit a doctor and about 60% of US adults reported feeling pain in the last three months.

Night shifts can now be added to the list of prejudices that might influence the prescription of analgesics, along with prejudices based on race and gender. Furthermore, it's the most recent investigation showing how detrimental night shifts may be if they're not adequately handled.

"These results highlight the need to address this bias by developing and implementing more structured pain management guidelines and by educating physicians about this bias," according to Gozal.

The research has been published in PNAS.