If you’re reading this, congratulations! You’ve survived the killing season!
Actually, it’s called the “July Effect” in America, and “The Killing Season” in Europe. In July (August in Europe), newly-minted medical students move on to residency, and rookie students take their place.
In the U.S., this time hosts a bump in morbidity. Some studies show as much as a 10% surge in fatal medication errors. Other studies show that it’s only the sickest patients who are affected (yikes!). Evidently, if you’re have a heart attack during the month of July, it might be best to have a friend drive you to a NON-teaching institution, and live to tell the tale.
I know of one memorable “July Effect” story that took place about 15 years ago in a major metropolitan teaching institution. A morbidly obese young woman came into the ER stating that she was pregnant, past due, and hadn’t felt the baby move for the last day or two. A new resident attended to her. He listened for fetal heart tones and heard a heartbeat around 60 beats per minute (WAY too slow for a fetus!) and proceeded to rush the young woman into the operating room for a stat c-section. You can guess the rest. The woman was mentally deranged. The resident had misinterpreted her heart rate as the (imaginary) baby’s. The OR crew performed a c-section on a woman who wasn’t even pregnant.
I was not personally involved in that surgery (whew!), but I can tell you that I worked with some of the people who were, and the entire crew felt horrible. My guess is that when the young woman regained her right mind, she wasn’t too thrilled, either. Here, I must digress for a moment: I personally know of two other instances in which women who were not pregnant presented for “delivery.” Fortunately in these two cases, cooler heads prevailed, and a quick ultrasound revealed the lack of a viable pregnancy. I also know of one case when a young woman was brought to the ER by her parents for abdominal cramping, and, to everyone’s surprise, she was nine month’s pregnant. Up to that point, all family members were clueless … I could entertain you for hours with such memories.
The July Effect has gone on for years, and there doesn’t seem to be a single, uniform cause. One obvious reason is failure in communication. New members of the medical team are reluctant to speak up for fear of seeming disrespectful or dumb.
Another cause is supervision itself. It’s one thing to impart new academic knowledge to a stranger, and quite another to convey how that knowledge applies to direct task performance. Imagine reviewing with someone the physics involved when a bowling ball hits a rack of pins, and then explaining to them how to bowl. Now, imagine explaining to a new member of the medical team how to insert an epidural into a mom’s back for labor and delivery. (I’ve tried – it’s darned near as scary as teaching a teenager how to drive).
Many people believe that the current nursing shortage also contribute to the whole mess. According to the Bureau of Labor Statistics, the RN workforce is expected to acquire 20% more nurses by 2020. This means that soon one out of five RNs will be relatively new to the medical field, and will contribute to an arena already fraught with high turnover. This decreases an institutional safety mechanism called performance cross checking, as when an experienced nurse or a pharmacist catches a trainee physician’s misstep. Performance cross checking is important for the management of every clinical case, but it’s a critical resource of crisis management.
Opportunities to enhance patient safety abound and the medical community is working on them. I believe one critical factor is to provide a public service announcement to inform health consumers themselves to be especially vigilant during the summer months. Don’t be afraid to speak up if something seems amiss, and ask, ask, ask if your gut tells you something’s not right. Now, take a deep breath—if you make it to September, you’ve survived the killing season.