You are to have elective surgery or you need to go to the hospital for a procedure. You may want to consider deferring this decision the month of July or in early August. Why? Conventional wisdom has long held that the quality of care in hospitals plummets during the month of July. But now a new study published in the Annals of Internal Medicine on July 11 confirms that suspicion.
Most newly minted doctors, interns, residents, fellows, and nurses graduate in June and begin working in hospitals on July 1. Teaching hospitals where doctors and nurses train have little experience caring for patients, often aren’t well supervised and don’t yet know the hospital system. As a result, patients remain in the hospital longer, and risk of complications and even death are higher in early July than the rest of the year. This finding is designated the “July Effect” in medical circles.
As a group, these physicians-in-training are supervised by fully trained doctors but from day one these new doctors are writing medication orders and doing certain procedures and diagnostic tests with relatively little direct supervision, so there’s always an opportunity for something to slip through the cracks and mistakes can be made.
Because on or around July 1, fresh, inexperienced interns, residents, nurses and other new health care workers first report to work at many of the nation’s hospitals, eager to start practicing medicine — on you. In medical circles it’s known as the “July effect.” The new study reviewed data from 39 previous studies that tracked health results in teaching hospitals — including death rates and complications from medical procedures. The best designed and largest studies, the authors found, showed mortality rates increase 4 to 12 percent in July and revealed that many patients remain in the hospital longer, spend more time in surgery and have higher hospital charges in July than in other months. After analyzing more than 62 million death certificates issued across the country from 1979 to 2006, researchers found that fatal medication errors consistently spiked in July by about 10 percent — but only in U.S. counties with many teaching hospitals — and then subsided in August to levels on par with other months. Yet there was no measurable increase in counties with facilities that don’t employ residents, such as community hospitals.
How protect yourself from the July Effect
• Bring your own health records (including a “Personal Medication Record”).
• Ask a friend, relative or other health advocate to stay with you.
• To lessen the chance of mix-ups, state your name to anyone providing you with care.
• Know the name of the doctor who is ultimately in charge of your care.
• Ask your doctor who will be doing the surgery or the procedure and consider asking him\her if they will promise to do it and have the new doctor serve as an assistant
Bottom Line: All surgery and all medical procedures have risks and complications but you can reduce these risks by avoiding a teaching hospital the month of July and early August.
This article was excerpted from “Why? New doctors and nurses report to work for the first time, eager to ‘practice’ medicine on you”
by: Sid Kirchheimer