July: Is It Safe?

If you're going to get sick, perhaps you should hold off until next month.  Or so you might think if you have heard of something called the "July phenomenon."

New doctors finish medical school and move on to graduate training programs in teaching hospitals across the country this month.  At more advanced levels of training, many others move up to positions with greater responsibility, including supervising those junior to them.  After completing post-graduate residency training, some newly-minted "real doctors" will take jobs as academic staff in teaching hospitals, and make the symbolic transition from learner to teacher.  At every level, then, it would seem there are doctors who are in brand new roles with responsibilities that are at least somewhat unfamiliar.

[Even at a hospital where there are no training programs, if you are a patient in the emergency department, the emergency physician taking care of you could be someone who just completed training in the specialty.  And that raises the more general and very interesting subject of wanting a doctor with plenty of experience. Come to think of it, I want that in my plumber, my electrician, and my car mechanic, too.]

Over the last 25 years numerous interesting studies have sought to examine and explore the notion of a July phenomenon.  I won't torture you with the details, but they seem to reach some straightforward conclusions.  More mistakes get made, but rates of significant complications (including death) are not higher.

Costs are somewhat higher, mainly because more junior trainees tend to order more tests.  This happens partly because they have less confidence in their clinical judgment and what they can learn from interviewing and examining a patient, and therefore have a greater inclination to rely on what they might find out by ordering lots of blood tests and imaging studies (x-rays, CAT scans, etc.).  It's also partly because they are still learning to be selective and judicious in ordering tests and to question the value of what each test might have to offer in illuminating the patient's condition.  The supervising doctors tend to be more focused on making sure the junior trainees don't miss anything and not quite as attentive to assuring that they practice cost-efficient medicine.

Is there an upside?  Maybe so.  There is a lot of enthusiasm and intensity in July. As newly graduated medical students assume some real responsibility, and those more senior take on supervisory roles, the fresh enthusiasm for learning and teaching makes July an exciting month.  (And I mean exciting in a good way.) There is some sense of anxiety that comes with new responsibilities, but that has a positive influence as well, as it gets everyone more intensely focused on doing the best possible job.  We are all determined not to screw up in whatever our new roles may be.  Sure, if you make a mistake, people will understand that can happen to a newbie, but no one wants to be branded a bungler.

I'm not recommending that you get sick or hurt this month, as opposed to any other month.   And it's not like you can plan such things, anyway.  But I do think it's reassuring to know that, on balance, the care you receive in our nation's teaching hospitals will be just as good in July as at any other time of year.