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Tired doctors often leave patients in unnecessary pain, Israeli study finds

At night, patients are 20% to 30% less likely to get painkiller prescription than from day-shift physicians, research shows

Nathan Jeffay is The Times of Israel's health and science correspondent

Illustrative image: a tired doctor (Iker Martiarena via iStock by Getty Images)
Illustrative image: a tired doctor (Iker Martiarena via iStock by Getty Images)

Doctors’ tiredness is literally hurting patients, according to new Israeli research, which found that physicians are far less likely to prescribe painkillers at night than  during the day.

A research team from the Hebrew University of Jerusalem and Hadassah Medical Center analyzed 13,482 discharge letters for patients in Israeli and American emergency rooms between 2013 and 2020.

The peer-reviewed findings, published Monday in The Proceedings of the National Academy of Sciences, concluded that if patients of the same age and facing the same medical conditions visited the ER at night, they were 20 to 30 percent less likely to leave with a prescription for painkillers than daytime visitors.

The researchers say it’s a stark warning that when doctors are tired — and possibly dealing with other features of night shifts such as increased stress — patient care is harmed. In many of the cases examined, doctors fell foul of World Health Organization recommendations by failing to prescribe painkillers.

“We were very surprised by what we discovered and that it’s not been documented until now,” Dr. Alex Gileles-Hillel, one of the authors of the study, told The Times of Israel. “The finding is clear — if you’d go home during the day with a painkiller prescription, you’re far less likely to get one at night.”

“Our suggestion is that empathy is lower at night time, and doctors’ perception of the pain of others is actually impaired at night, when they are tired,” he said.

Illustrative image: an emergency room at night (MrAlanC via iStock by Getty Images)

Dr. Anat Perry, another member of the research team, noted that the bias remained significant even after adjusting for patients’ reported level of pain, patient and physician’s demographics, the type of complaint and other factors.

Perry commented: “Our takeaway is that night shift work is an important and previously unrecognized source of bias in pain management, likely stemming from impaired perception of pain. Even medical experts, who strive to provide the best care for their patients, are susceptible to the effects of a night shift.”

As well as analyzing media records, the researchers tested doctors to judge their level of empathy at different times. They gave them as series of tasks that can be used to gauge empathy at the end of a 26-hour shift or just beginning their workday. Doctors who recently completed night shifts showed less empathy for pain. For example, when asked to rate the likely level of pain of a patient in a photo, they consistently rated it as lower than doctors working day shifts.

The research team behind the study on doctors and night shifts, from left to right, Anat Perry, Shoham Choshen-Hillel, and Alex Gileles-Hillel. (courtesy of Hebrew University)

Gileles-Hillel said that the research should prompt increased efforts to counter doctors’ tiredness and encourage the use of technology that helps physicians with their decision making and prompts them to consider painkillers in response to certain complaints.

He said the research also highlights the need for wider conversations about the impact of tiredness. “This study was about doctors, but we should also explore the impact that tiredness has on meeting needs in other areas off life, for example parents to children. Sleep deprivation is very pervasive in our society, so this is important.”

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