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Doctor fatigue harms patients in a physical sense, according to new Israeli research that found doctors were less likely to prescribe painkillers at night than during the day.
A research team from the Hebrew University of Jerusalem and Hadassah Hospital analyzed 13,482 discharge letters from patients who presented between 2013 and 2020 in emergency rooms in Israel and the United States.
These findings, published Monday in the peer-reviewed journal Proceedings of the National Academy of Sciencesestablish that if patients of a similar age and affected by the same pathology attend the emergency room at night, they are between 20% and 30% less likely to leave the service with a prescription for analgesics than is the case of patients who come during the day.
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The researchers note that these findings underscore that when physicians are fatigued and experience other consequences of night shifts, such as increased stress, patient care suffers. In a large number of the cases examined, doctors contravened the recommendations of the World Health Organization due to their inability to prescribe analgesics.
“We were surprised by what was discovered and until today no data had been collected on the subject,” Dr. Alex Gileles-Hillel, one of the study’s authors, explains to the magazine. israeli times. “The findings are clear: If she can go home during the day with a prescription for pain medication, that’s much less likely to be the case if she goes to the ER at night.”
“Our hypothesis is that empathy is less strong at night and that doctors’ perception of pain is altered when they are tired,” he suggests.
Illustrative photo: Emergencies at night. (Credit: MrAlanC via iStock from Getty Images)
Dr. Anat Perry, another member of the research team, notes that this trend remains significant even after adjusting for reported pain level, physician and patient profile, type of patient complaint, and other factors .
Perry states that “what we take away is that night shifts are an important source of influence in pain management, a source that was not recognized until now and that emanates from an altered perception of suffering. Even medical experts, who strive to provide the best care for their patients, are susceptible to being influenced by the effects of night shifts. »
In addition to analyzing hospital records and materials, the researchers tested doctors to judge their level of empathy at different times. They were given a series of tasks to complete that were used to determine their level of empathy at the end of a 26-hour shift or the start of their workday. Physicians who had just finished night shifts showed less empathy for pain. For example, when asked to judge a patient’s level of suffering based on a photograph, they always underestimated her suffering compared to the judgment made by the doctors on the day shift.
The research team behind the study of physicians’ day and night shifts, from left: Anat Perry, Shoham Choshen-Hillel, and Alex Gileles-Hillel. (Courtesy Hebrew University)
Gileles-Hillel indicated that the research should give rise to a whole range of works to combat the fatigue of doctors and encourage the use of technologies that help them in decision-making, as well as lead them to take anti-pain into account as response to certain complaints
He explained that the research also underscores the need to look more broadly at the impact of fatigue. “This study is about doctors, but we should also look at the effect of fatigue on interactions in all areas of life, for example, parent-child interactions. Sleep deprivation is a pervasive phenomenon in our society and is therefore an important issue,” she concluded.