COLUMBIA, Mo. — Here’s hoping your doctor has a great bedtime routine. New findings by a team at the University of Missouri-Columbia reveals sleep deprived physicians have less empathy for patients in pain. In other words, if your doctor is a night owl, you may find it much harder to get prescriptions for pain medications.
Study authors assessed 31 resident physicians in Israel just starting their workday, as well as an additional 36 resident physicians wrapping up a long 26-hour shift. Each participant read about two hypothetical patient scenarios: a female patient with a headache and a male patient with a backache. Researchers then asked the physicians questions about the fictional patients’ pain levels, and how likely they would be to prescribe pain medications.
Sure enough, doctors finishing a long shift displayed far less empathy for the patients than their more refreshed medical colleagues.
“Pain management is a major challenge, and a doctor’s perception of a patient’s subjective pain is susceptible to bias,” says study co-author David Gozal, MD, the Marie M. and Harry L. Smith Endowed Chair of Child Health at the MU School of Medicine, in a university release. “This study demonstrated that night shift work is an important and previously unrecognized source of bias in pain management, likely stemming from impaired perception of pain.”
Patients in pain during the night less likely to get painkillers
Next, researchers analyzed a collection of over 13,000 electronic medical record (EMR) discharge notes pertaining to patients arriving with pain complaints at both American and Israeli hospitals. In line with their other findings, the propensity of doctors on the night shift to prescribe analgesics was lower in both countries (11% lower in Israel, 9% lower in the U.S.).
“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,” Gozal adds. “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.”
In light of these findings, study authors theorize it may be advantageous for hospital schedule makers to stagger resident physician work schedules and night shifts to help mitigate the effect of exhaustion on empathy.
The study is published in the Proceedings of the National Academy of Sciences.