Doctors May Under-Prescribe Pain Meds During Night Shifts

Under-prescription of pain medications occurs during night shifts, according to a study published online June 27 in the Proceedings of the National Academy of Sciences.

Shoham Choshen-Hillel, Ph.D., from the Hebrew University of Jerusalem in Israel, and colleagues explored the timing of physicians’ work as a previously unrecognized source of systematic bias in pain management in two studies. In the first, 67 resident physicians performed empathy for pain assessment tasks and simulated patient scenarios in laboratory conditions following a night shift or not. In the second study, this phenomenon was explored in medical decisions. Discharge notes of 13,482 patients arriving with pain complaints during 2013 to 2020 were analyzed from three emergency departments in Israel and the United States.

The researchers found that as predicted, in study 1, physicians showed reduced empathy for pain following a night shift. In the second study, physicians were less likely to prescribe an analgesic during night shifts versus daytime shifts, and they prescribed fewer analgesics than recommended by the World Health Organization. After adjustment for patient, physician, type of complaint, and emergency department characteristics, this effect remained significant. For opioids, under-prescription for pain during night shifts was particularly prominent.

“We show robust evidence that physicians’ pain management decisions are impaired during night shifts,” the authors write. “Our findings highlight the need to implement more structured pain management guidelines in hospitals and seek improved physician working schedules.”

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