28 June 2022

Cranky docs don’t feel your pain

The Back Page

Night shift wreaks havoc on empathy, even leading to withholding of painkillers.


If you’re coming off the night shift while reading this, go easy on us.

A study combining a lab experiment and archival data from US and Israeli hospitals has found that doctors after night shift tend to be a little less … indulgent … than their day shift co-workers, to the point where they give patients less pain medication.

The authors hypothesised that “during night shifts, sleep deprivation, fatigue, and stress would reduce physicians’ empathy for others’ pain, leading to underprescription of analgesics for patient pain relief”.

In the lab bit of the study, 67 doctors were given empathy assessment tasks and simulated patient scenarios to respond to. They were either beginning their work day or, and we don’t think this is a typo, coming off a 26-hour shift.

It takes a lot less than 26 hours awake to turn your Back Page correspondent into an extra from Day of the Dead, so the fact that any of these doctors stuck around to do the tests says something for their fortitude already.

As predicted, the night shift group showed less empathy for patients’ pain, had reduced emotional responses to images of people in pain, and scored their patients lower on pain charts.

The researchers then looked at real decision-making by doctors using three emergency department datasets, including seven years of discharge notes for patients who had come to hospital complaining of some kind of pain. Physicians were less likely to prescribe analgesics after a night shift, and the effect remained solid after adjusting for “patient, physician, type of complaint, and emergency department characteristics”.

“We conclude that night shift work is an important and previously unrecognised source of bias in pain management, likely stemming from impaired perception of pain,” the authors wrote in the paper, which was published in PNAS.

Given that the effect was “particularly prominent for opioids”, and given this other new study suggesting opioid prescription at discharge increases adverse events without reducing pain, maybe a little tough love has its accidental upside.

If you see something that causes you to run out of damns to give, prescribe it to penny@medicalrepublic.com.au.

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