A recent international study conducted by the University of Missouri School of Medicine and Israeli researchers discovered that sleep-deprived doctors had less empathy for their patients’ misery and that this perception influences their prescription behaviours.
The study’s findings were published in the journal “Proceedings of the National Academy of Sciences.” The study included 31 Israeli resident physicians who were just starting their day and 36 who were finishing up a 26-hour shift. They went over a clinical scenario with a female patient with a headache and another involving a male patient with a backache. The physicians were then asked about the severity of their patients’ suffering and their proclivity to prescribe pain drugs.
The clinicians towards the end of their shifts showed much less empathy for the patients than those just beginning.
“Pain management is a serious difficulty, and a doctor’s evaluation of a patient’s subjective pain is sensitive to prejudice,” said co-author and MU School of Medicine Marie M. and Harry L. Smith Endowed Chair of Child Health David Gozal, MD. “This study indicated that night shift employment is a significant and previously undetected source of bias in pain treatment, most likely due to poor pain perception.”
To back up their findings, the researchers examined over 13,000 electronic medical records (EMR) discharge notes from patients who arrived at hospitals in Israel and the United States with pain complaints.
The study discovered that doctors’ tendency to administer analgesics to patients presenting with acute pain during the night shift was 11% lower in Israel and 9% lower in the United States.
“The fact that analgesic prescription divergence from general World Health Organization criteria is larger during night shifts shows that there is really an under-prescription during night shifts, rather than an over-prescription during day shifts,” Gozal added. “These findings underline the need of addressing this bias by designing and adopting more organised pain treatment standards, as well as teaching clinicians about it.”
Sleep deprivation reduces empathy
According to Gozal, it is also critical to explore if hospitals might adjust resident physician work patterns to minimise empathy or decision fatigue.
Koby Clements, senior director of value-driven outcomes and analytics at MU Health Care, and Adrienne Ohler, PhD, associate research professor, were members of Gozal’s MU study team.
Shoham Choshen-Hillel, PhD, associate professor at Hebrew University; Alex Gileles-Hillel, MD, assistant professor at the Hadassah-Hebrew University Medical Center; and Anat Perry, PhD, assistant professor at Hebrew University comprised the multinational group. Tom Gordon-Hecker, PhD; Shir Ganzer and Salomon Israel from Hebrew University; David Rekhtman and Ido Sadras, MD, from Hadassah-Hebrew University Medical Center; and Eugene M. Caruso, PhD, associate professor at UCLA, were also co-authors.
“Physicians Prescribe Fewer Analgesics During Nightshifts Than Dayshifts,” their research, was just published in the journal Proceedings of the National Academy of Sciences of the United States of America.