Sex bias in pain management decisions.

In the pursuit of mental and physical health, effective pain management stands as a cornerstone. Here, we examine a potential sex bias in pain management. Leveraging insights from psychological research showing that females' pain is stereotypically judged as less intense than males' pain, we hypothesize that there may be tangible differences in pain management decisions based on patients' sex. Our investigation spans emergency department (ED) datasets from two countries, including discharge notes of patients arriving with pain complaints (N = 21,851). Across these datasets, a consistent sex disparity emerges. Female patients are less likely to be prescribed pain-relief medications compared to males, and this disparity persists even after adjusting for patients' reported pain scores and numerous patient, physician, and ED variables. This disparity extends across medical practitioners, with both male and female physicians prescribing less pain-relief medications to females than to males. Additional analyses reveal that female patients' pain scores are 10% less likely to be recorded by nurses, and female patients spend an additional 30 min in the ED compared to male patients. A controlled experiment employing clinical vignettes reinforces our hypothesis, showing that nurses (N = 109) judge pain of female patients to be less intense than that of males. We argue that the findings reflect an undertreatment of female patients' pain. We discuss the troubling societal and medical implications of females' pain being overlooked and call for policy interventions to ensure equal pain treatment.

Physicians prescribe fewer analgesics during night shifts than day shifts.

Adequate pain management is one of the biggest challenges of the modern healthcare system. Physician perception of patient subjective pain, which is crucial to pain management, is susceptible to a host of potential biases. Here we explore the timing of physicians' work as a previously unrecognized source of systematic bias in pain management. We hypothesized 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 study 1, 67 resident physicians, either following a night shift or not, performed empathy for pain assessment tasks and simulated patient scenarios in laboratory conditions. As predicted, following a night shift, physicians showed reduced empathy for pain. In study 2, we explored this phenomenon in medical decisions in the field. We analyzed three emergency department datasets from Israel and the United States that included discharge notes of patients arriving with pain complaints during 2013 to 2020 (n = 13,482). Across all datasets, physicians were less likely to prescribe an analgesic during night shifts (compared to daytime shifts) and prescribed fewer analgesics than generally recommended by the World Health Organization. This effect remained significant after adjusting for patient, physician, type of complaint, and emergency department characteristics. Underprescription for pain during night shifts was particularly prominent for opioids. We conclude that night shift work is an important and previously unrecognized source of bias in pain management, likely stemming from impaired perception of pain. We consider the implications for hospitals and other organizations employing night shifts.

Cognitive empathy boosts honesty in children and young adolescents.

Children and young adolescents often tend to behave dishonestly in order to serve their self-interests. This study focused on how empathic abilities affect children's tendency to deceive others. Deception is the act of causing others to form a false belief to get them to act in a way that serves the deceiver's interests. As such, it requires the ability to predict how others might use the provided information. In two experiments, 274 participants (aged 10-16 years) played a game in which they could send a deceptive message to another participant to boost their own payoff at the other player's expense. We measured participants' cognitive and emotional empathy using different measures. We found that a measure of cognitive empathy, namely the fantasy scale, was associated with less deception of another player when that other player was not identified and was presented only as "Player B." However, when Player B was identified by name, empathy did not predict deception. In such cases, the only factors affecting deception rates were the gain for the participant (higher possible gains lead to more deception) and loss to the other player (higher possible losses lead to less deception). Overall, the findings suggest that even by 11 years of age, children can understand the impact of their unethical behavior on another child and adjust their actions accordingly. However, when the other child is not identified, children need to possess high levels of cognitive empathy toward imagined individuals to resist the temptation to deceive the other child.

Justifications shape ethical blind spots.

To some extent, unethical behavior results from people's limited attention to ethical considerations, which results in an ethical blind spot. Here, we focus on the role of ambiguity in shaping people's ethical blind spots, which in turn lead to their ethical failures. We suggest that in ambiguous settings, individuals' attention shifts toward tempting information, which determines the magnitude of their lies. Employing a novel ambiguous-dice paradigm, we asked participants to report the outcome of the die roll appearing closest to the location of a previously presented fixation cross on a computer screen; this outcome would determine their pay. We varied the value of the die second closest to the fixation cross to be either higher (i.e., tempting) or lower (i.e., not tempting) than the die closest to the fixation cross. Results of two experiments revealed that in ambiguous settings, people's incorrect responses were self-serving. Tracking participants' eye movements demonstrated that people's ethical blind spots are shaped by increased attention toward tempting information.

Not taking responsibility: Equity trumps efficiency in allocation decisions.

When allocating resources, equity and efficiency may conflict. When resources are scarce and cannot be distributed equally, one may choose to destroy resources and reduce societal welfare to maintain equity among its members. We examined whether people are averse to inequitable outcomes per se or to being responsible for deciding how inequity should be implemented. Three scenario-based experiments and one incentivized experiment revealed that participants are inequity responsibility averse: when asked to decide which of the 2 equally deserving individuals should receive a reward, they rather discarded the reward than choosing who will get it. This tendency diminished significantly when participants had the possibility to use a random device to allocate the reward. The finding suggests that it is more difficult to be responsible for the way inequity is implemented than to create inequity per se. (PsycINFO Database Record