Effect of shift work on patient-doctor relationship in emergency department

A basic principle for the best medical care is the quality of relationship between doctor and patient1 and it is an important concept in health care especially emergency care. Many publications in the medical care have indicated that the ‘medical health service’ will improve if attention is paid to improve the patient-doctor relationship. There is a tendency to link difficult patient-doctor relationship to difficult patients.2–7 The difficult patient-doctor relationship is generally discussed from the patient's perspective and the instruments used to measure physician responses. There are a few studies that explored the patient-doctor relationship from the patient's perspective. Furthermore, there is also a complex situation in Emergency Medicine (EM) as a unique specialty which focuses upon providing a breadth of coverage for acute care whenever it is needed.8–10 Since emergencies happen at any time of day or night and require immediate expert care, shift work is an essential component of EM practice. It has been found in many studies that shift work can disrupt human circadian rhythms which are normally acclimated to daytime wakefulness and nighttime rest.11,12 At the physiological level, medical investigations have demonstrated that circadian desynchronization can lead to changes in hormonal levels, increase the risk of cardiovascular disease, produce sleep-cycle disturbances and result in significant fatigue.13–22 However, there is not any study that evaluated the effect of shift work on patient-doctor relationship which is the most important issue in medical care from the patient's perspective. This study dealt with the effects of shift work on patient- doctor relationship from the patient's perspective in emergency medical practice.