Wednesday, June 29, 2011

The July Effect

July First is Friday. That means I will be responsible for the health of children other than my own in two days. Good thing I've had eight months of practice with my own son.

There is always a lot of talk about how it is most dangerous to go into the hospital in July. You can find a lot of articles like this one from USA Today or this one from Newsweek that talk about patient deaths attributed to new residents in July. The basic idea is that July 1st is the start of a new academic year. All of the medical students are new, all the interns are new, the second year residents are really just interns +1 additional day, the attendings just graduated from their own programs, etc etc. [The attending doctor is the fully trained, supervising physician/professor in charge of the residents & students.] When you're new (and nervous) you make more mistakes, and theoretically that translates into worse medical care.

Should you really be scared to go to a training hospital in July?

One thing to remember is that the supervision is assuredly stricter in teaching hospitals in July. From what I hear from those that have trained before me, supervision in medicine, in general, is more strict now than it was years ago. There are more regulations - like duty hour regulations, and documentation regulations - than ever before. I have had attendings and preceptors tell me that they moonlighted [were paid to be work overnight] in their training ... as medical students! Interns are just not thrown in the way they once were.

The nurses are also not new in July. Some nurses have been working the same unit for many years, and frequently know more than the doctors that are taking care of the same patients.

If you go to a teaching hospital, you have multiple health care professionals evaluating you. If you go to a private hospital, you have the nurse calling your doctor, who comes in to see you at some point. (Or a hospitalist sees you instead.) That's about it.

I also looked up the study that the above mentioned USA Today article cites. There are multiple flaws with the study. The study only can show correlation of patient deaths in July, not causation by residents; the data is based on previous years where reporting may not have been as strict; only one type of error is evaluated, etc etc.

I don't think that overall medical care is worse in July, but I am going to guess it's slower. A lot slower.

Bottom line: all of the new pediatricians are going to be awesome. But you may want to avoid all those new surgeons ...

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