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A recent study found that physician cognitive load influences pain treatment decisions, with physicians prescribing weaker analgesics to high socioeconomic status (SES) patients compared to low SES patients.

The following is a summary of “Impact of Patient Race, Patient Socioeconomic Status, and Cognitive Load of Physician Residents and Fellows on Chronic Pain Care Decisions,” published in the January 2024 issue of Pain by Anastas et al.

Social stereotypes may wield greater influence in medical decision-making, especially when physicians are under a high cognitive load or mental workload. This study investigated the interplay of patient race, socioeconomic status (SES), physician cognitive load, and physicians’ implicit beliefs regarding racial and SES differences in pain tolerance on pain treatment decisions. 

A cohort of physician residents and fellows (N=120) was tasked with making treatment decisions for computer-simulated patients with back pain, varying in race (Black/White) and SES (low/high). The physicians were randomly assigned to either a high cognitive load group, interrupted for hypertension medication conversion calculations, or a low cognitive load group. Despite equal time allocation for pain care decisions (2.5 minutes/patient), multilevel ordinal logistic regression analyses revealed that physicians prescribed weaker analgesics to patients with high SES compared to low SES (OR=0.68, 95% CI [0.48, 0.97], p=0.03). 

Additionally, a patient SES-by-cognitive load interaction (OR=0.56, 95% CI [0.31,1.01], p=0.05) was observed, although not statistically significant at p<0.05. These findings underscore the significance of physician cognitive load as a clinically relevant factor influencing pain care quality and equity.

 Source: sciencedirect.com/science/article/abs/pii/S1526590024003547