Study Finds Doctors Prescribe Fewer Painkiller During Nightshifts than During the Day

By Hamodia Staff

YERUSHALAYIM – A new study has found that doctors prescribe less pain medication during hospital nightshifts than during the day, which may carry broad implications for professionals in other fields working under similar sleep-deprived conditions.

A research team from Hebrew University and Hadassah Medical Center in Yerushalayim conducted a two-part study: In the first part, 67 doctors were given empathy assessment tasks in the morning and asked to respond to simulated patient scenarios. These doctors were either at the end of a 26-hour shift or just beginning their workday. The study found that doctors who recently completed night shift showed less empathy for patient’s pain. For example, these physicians’ exhibited decreased emotional responses to pictures of people in pain and consistently scored their patients low on pain assessment charts.

In the second part of the study, the researchers analyzed actual medical decisions made by emergency room doctors in the United States and Israel. In all, they studied 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,” explained HU’s Professor Shoham Choshen-Hillel. 

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,” noted the HU Psychology Department’s Dr. Anat Perry.

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 Dr. Alex Gileles-Hillel from Hadassah Medical Center and HU.