As my return to general surgery residency rapidly approaches, I’m reminded of this article in the New York Times called “Focus on Hospitals’ ‘July Effect'”.
We’ve all heard the line “don’t go to the hospital in July or August” or “pray you don’t get sick in July/August”. That’s because medical students, who graduated a mere month and a half prior, enter the hospital world as interns. Similarly, trainees at all levels “move up” to the next level of residency, taking on greater responsibility for patient care. The concern with July and August is that novice physicians are more likely to make mistakes, potentially jeopardizing care quality and patient safety.
There are some studies to show that there truly is a July effect; as newly minted doctors “learn the ropes” and ascend the steep learning curve of medicine, there are bound to be a few mistakes along the way. Worse yet, some of these recent medical school graduates are truly not cut out to be physicians (or not meant to practice their chosen specialty), making them more prone to error.
But as the NYTimes article points out, researchers studying admissions for spinal surgery showed no difference for in-hospital mortality rates in July, and probably more striking, no difference in outcomes for high risk and sicker patients.
I’ve always thought that much of the July/August effect was negated by greater vigilance on the part of senior residents and attending physicians. Knowing that interns have recently graduated from medical school, senior house officers and staff are more likely to double and triple check the care provided by interns. Also, interns in July and August are more likely to ask questions and seek guidance… simply because they don’t know the answers and are scared to make the wrong decisions. I’ve always worried more about September/October, when interns have gained a little experience, begin to think they know the right answer, and are less likely to ask for help. Similarly, senior residents begin to relax and trust interns more at this point in time. I have no evidence to support this whatsoever, but could make for an interesting study.