By Vanessa Radatus
As July nears its end, those of us who avoided an emergency visit to the hospital this month can be especially thankful to have dodged what is known to be the “July Effect”. This little-noticed phenomena emerges every year in hospitals nationwide as newly graduated medical school students learn how to be doctors in their first month. But are they ready? Recent studies suggest they’re not.
A study by UC San Diego researchers David Phillips and Gwendolyn Barker revealed that in counties with teaching hospitals, fatal medication errors spiked by 10% in July and in no other month, they reported in the Journal of General Internal Medicine. The study also found that the greater the concentration of teaching hospitals in a region, the greater the July spike, and counties without teaching hospitals experienced no such increase. Barker and Phillips studied data obtained from 62.34 million computerized death certificates from 1979 to 2006, focusing on 244,388 deaths involving medication errors.
“Medication errors are the second-leading cause of accidental death, and the only kind of accidental death that is increasing over time,” said David P. Phillips, PhD. who has studied medication errors – those attributable to patients as well as to health care professionals – for more than 30 years.” Read More…
In a New York Times article, “Don’t Get Sick In July,” Theresa Brown, an oncology nurse wrote an opinion piece about her personal experience with the “July Effect” and how it affects the well-being of patients. She explains how new residents are M.D’s on the books, but have little to no experience in actual doctoring. Her insight sheds light on the issue of doctor-nurse-patient relations and how “The July Effect brings a sharp relief of reality: Care is becoming more specialized, and nurses, who sometimes have years of experience, often know more than the greenest physicians.” Read more…
In an equally interesting article, “Why You Should Never Go to the Hospital in July,” a first-year resident recounts his first night on call in July following his graduation from medical school. Anthony Youn both reinforces Theresa Brown’s reality that nurses are essential teachers in this trial period and also the idea that new residents need more supervision and less crucial responsibilities. He says:
“Like most interns, I arrived with four years of medical school under my belt, an M.D. after my name, and virtually no practical knowledge of medicine. Although I wore the long white coat of a doctor, I kept my pockets packed with condensed medical manuals that we called our “peripheral brains” to make up for the lack of knowledge held in my actual brain. Thank God for these manuals. Otherwise I would have been part of “The July Effect.” Read More…
He goes on to explain a horrific event on his first night on-call and how he nearly killed a patient whose heart monitor was in ventricular fibrillation, the heart rhythm that immediately precedes death. Had it not been for a nurse who showed him were to place the paddles on the patients chest, Anthony would have shocked the liver instead of the heart. His story is not only alarming because this one month is basically a period of trial and error for new doctors but also because we as patients have virtually no idea how much experience a doctor has unless we ask or research before. And for the Anthony’s patient who was in cardiac arrest, he had no choice in whether a rookie saved his live – or nearly killed him.
However, we must realize that like any new job, it takes everyday experience in the field to improve. The co-author of the study, David Phillips said the research suggests new residents “learn quickly” from mistakes made that month. “Within a month, they’re up to speed.”
He said he hopes the study will “encourage officials at teaching hospitals to reevaluate what responsibilities are given to new residents, increase supervision and bolster education on medication safety.”
Not studied is the fact that by June, housestaff has reached such a skill level that many patients are kept alive who might otherwise have not survived. Then July hits, and these truly expert physicians have gone to other jobs, and the overall skill level is down. It is possible that the July rate is normal and the June rate is extraordinary.