With Medical Errors, is the “July Effect” Fact or Fiction?

by Godfrey Onime

Tired resident
From Well-Being Index

At the physicians’ lounge recently, a colleague asked me, “How are the new interns? Aren’t you glad another July is over?”

I told him that our new class of first-year medical residents, or interns as they are commonly called, seemed quite strong. As for his celebratory comments about the vanquishing of July, I knew what he meant. After all, a common sage in American teaching hospitals is, “Don’t get sick in July.” The reason for this sentiment is because that’s when most of the doctors are the most green, or inexperienced.

It happens that when we consider medical errors, the level of experience of a doctor or other healthcare providers — as with any profession for that matter — is quite important. Less experience often equals more mistakes – from writing to accounting to carpentry. These screwups can become learning opportunities for these professionals. But medicine is different. Often, people die.

The so-called July effect in American teaching hospitals is one example of how inexperience can come to bear in the vexing world of medical errors. For one, July 1st or thereabout is the date when fresh medical school graduates transform into new interns, ready to practice — on you. That’s when they begin to zig-zag about the hospitals at frenzied paces in their yet shinny, starched white coats and introducing themselves as Dr. Superman (or woman). To truly understand the forces at play here, let’s for a moment get into the head of the new intern. Read more »

Hail, the one-eyed King: 30 years after the contested Harvard Medical Practice Study on Medical Errors

by Godfrey Onime

Scissors on Chest X-Ray
Scissors on Chest X-Ray

A few months ago, I walked into a patient’s hospital room, introduced myself, and sat on a chair next to her bed. After a quick review of her condition, I stood to examine her. The woman stopped me. 

“No offense, Doc,” she said, “but did you wash your hands?” 

I was shocked by the seemingly simple question. No patient had ever before challenged me in this direct manner. I explained that I had indeed used the disinfectant solution by her door before entering. But I proceeded to wash my hands at the sink in her room anyway, making a show of using ample soap and scrubbing as high up as my elbows. Then, I examined her. 

Concerning her challenge, the woman explained the source of her empowerment. She’d learned that according to a governmental report, medical errors kill nearly 100,000 Americans per year–perhaps a low estimate. She also understood that a large proportion of the deaths are related to hospital-acquired infections, which nurses and doctors can introduce by not washing their hands before touching patients. 

I was familiar with the report. It is the now-famous Institute of Medicine’s (IOM) 1999 publication, To Err is Human. It attributed the dismaying figures of 48,000 to 98,000 deaths per year to medical errors. That number would translate to a Titanic cruise ship crammed full of people crashing into an iceberg every one to two weeks, killing everyone on board. The press ran with the numbers—statistics that are still widely cited today. But the report also drew intense criticisms, notably concerning the research from which those figures were gleaned, particularly the estimate of 98,000 deaths. Read more »