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Why you should never go to the hospital in July
June 22nd, 2011
01:00 PM ET

Why you should never go to the hospital in July

Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor. 

Do not get sick in July. Why? You might die.

A recent study published by the Journal of General Internal Medicine reported a 10 percent spike in teaching hospital deaths during the month of July due to medical errors. We call this spike “The July Effect” and we attribute it to the influx of new interns and residents.

Typically, medical students graduate in June and begin their first year of residency training — internship — in July. This group of eager new interns invades the hospital to learn, care for patients, and make medical decisions. One problem. They don’t know what they’re doing.

Like most interns, I arrived with four years of medical school under my belt, an M.D. after my name, and virtually no practical knowledge of medicine. Although I wore the long white coat of a doctor, I kept my pockets packed with condensed medical manuals that we called our “peripheral brains” to make up for the lack of knowledge held in my actual brain. Thank God for these manuals. Otherwise I would have been part of “The July Effect.”

My first night on call. I walk down a dimly lit hallway toward my call room, the only sound the intermittent beeping of a heart monitor. Suddenly, a loud siren rings overhead. A nurse rushes out of a room right in front of me.

“Call a code!” she yells to a secretary. The nurse looks in my direction and asks, “You’re a resident, right? I need you to run this code!”

I look left, right, and behind me.

Gulp. She’s talking to me.

“OK,” I say, hoping that she hasn’t noticed that my voice has leaped an octave.

The truth is, I’ve just finished orientation, which included a course in Advanced Cardiac Life Support, but I have not spent a minute reviewing the manual. Confession: I’m not feeling all that confident.

I rushed with the nurse into the patient’s room. I see on the cardiac monitor that the patient is in ventricular fibrillation, the heart rhythm that immediately precedes death. Squeezing an oxygen mask, a nurse stands above the patient’s head. A second nurse runs medications into an IV.

“What should we do, doctor?”

My mind goes blank. I have absolutely no idea.

I pull out my “peripheral brain,” flip to the section on “ventricular fibrillation.” Aha! Got the treatment. Cardioversion - commonly called electric shocks.

[By cardioversion, I'm using a general term for restoring a heart to its correct rhythm. ]

“Get me the paddles!” I say, my voice rising.

The nurse shoves the paddles into my hands and sets the power to the appropriate level.

“Clear!” I yell, and place the paddles on the patient’s chest.

“STOP!” the nurse screams.

She grabs my hands and moves the paddles to a different spot on the patient’s chest.

One more second and I would have shocked his liver.

“Clear!” I yell again, and press the defibrillation button.

The patient jerks slightly and for an instant the heart monitor goes wild. Then it completely stops. We stand still, staring at the monitor for what seems like minutes, awaiting his new cardiac rhythm.

Beep… beep… beep.

Normal.

He’s saved.

I let out a breath of relief.

Within seconds, several residents enter the room and take over for me. I gladly step aside. I go back to my call room, both exhilarated that I’ve saved a patient’s life and freaking out that I nearly made a mistake would have cost it. I’ve learned my lesson. I pull out my heart book and study it cover-to-cover until dawn.

Everyone - even doctors, especially doctors - have to learn and train in order to become proficient. Interns start out as rookies, not seasoned veterans. Experience takes time.

So if you have to go to a hospital in July, treat the new interns with patience and respect.

Then check with your nurse to make sure they know what they’re doing.


soundoff (565 Responses)
  1. HPNIII

    Well I'm betting this guy is going to have a hard time finding a partner at the tator sac race at the next AMA convention. I just really don't like the medical industry with all their god like arrogance. Why is it the trucking industry has enough common sense to know that a trucker doesn't need to drive 24 hours straight,yet the medical industry will take new inexperienced interns and put them on a 24 hour shift. It's not enough they don't know what they are doing, but they are half asleep on top of it all.

    June 23, 2011 at 09:10 | Report abuse | Reply
    • sue white

      It would have been really nice if the above Dr. had stated he was happy that the "nurse" saved the patient,since she was the one who STOPPED him from shocking the patient's liver!!!!!!!!!!

      June 23, 2011 at 11:00 | Report abuse |
    • piercyguest

      Actually residents and interns are no longer allowed 24 hour shifts, in our ED they can only work 10 hours, and this is cut down from 12 hours.

      June 24, 2011 at 12:03 | Report abuse |
    • Aaron L.

      No doctor should be allowed to touch a person if they've been working longer than 10-12 hours. I don't care how good they are. They could seriously screw someone up pretty bad.

      June 25, 2011 at 17:33 | Report abuse |
    • newdoc

      There are new resident work hour guidelines put into place this year (I would know I'm one of those new doctors). We can only work 16 hours straigh for a maximum of 80 hours per weekt, must have 10 hours off in between shifts, and must have 1 day off a week This is a vast improvement from the 120 hour work weeks physicians had in the past. 16 hours may seem like a lot but this is actually very manageable. Also, with shorter work hours, patients are "handed-off" from caregiver to caregiver more often, opening up a possibility for many more errors. Residency programs are trying to minimize the number of hand-offs to minimize the number of medical erros. Afterall, most physicians take the care of their patients very seriously and want to provide the best medical treatment they can. People are really cynical about physicians, sometimes for good reason but most have only the best intentions.

      June 26, 2011 at 17:35 | Report abuse |
    • DMGMD

      Really, what is with people and the accusations of "godlike arrogance"? Are these charges because the physician or surgeon knows volumes more than the average patient about the human body? Well guess what...that's what is required of them! Yes, we do have to work long hours, yes sometimes more 36 hours. Why? Because there aren't enough of us, and no nurses aren't trained to do what we do...otherwise they'd be doing it. At 2:30am when you or your loved one is in need of the only trauma surgeon available in some small town, maybe you should ask the question "has this surgeon been through a training program that demanded he perform when he was dead tired". Because you don't want one who has only worked 40 hours a week. Yes, thank the nurse, but as every new intern will find out sooner or later, you have to rely on your own training and judgement. There is controversy over the July effect and if it really should be blamed on the new interns...new nurses start around that time too you know.

      June 26, 2011 at 17:43 | Report abuse |
    • Oxazaborolidine

      Pointing out that there is controversy behind the so-called July effect is good as it points out that the problem is probably more complex than an influx of new graduates. As the above article illustrates we patients depend on the checks and balances provided by the whole of the medical system, which, when grossly simplified, can be boiled down to the interaction of the various medical professionals, regardless of level of training. In short, everyone has to know what they are doing. We all learn from those around us as the author of the blog acknowledged when admitting the nurse corrected the position of his paddle. An above poster, whether through indignation, ignorance, arrogance, or just momentary passion, seemingly tried to shift blame from new interns to new nurses. If this was indeed the intent, then I hope this person is able to see that such statements lead to altered perception. Personally I want my medical professionals to work together not place blame. To be simplistic, but truthful, all beginners make mistakes - the difference here is that our medical interns are on a path to a pinnacle of responsibility, and so society quite fairly expects more from them

      June 27, 2011 at 01:10 | Report abuse |
    • theparamount

      Maybe you should read the new ACGME rules on Intern work load hours (16 max, always supervised, with a minimum 8 hours off)...

      Also physicians learn by experience, you have to be there, you have to see it to learn from it. It's hard to learn when you miss things, which is why interns and other residents can be found wandering the hospital at night.

      June 27, 2011 at 21:31 | Report abuse |
    • cmp031000

      well wouldnt you love to know that interns can only work 16 hours straight...might want to get your facts straight before you open your mouth.

      September 21, 2011 at 11:37 | Report abuse |
  2. twotired

    "I arrived with four years of medical school under my belt, an M.D. after my name, and virtually no practical knowledge of medicine." I have a similar experience in another profession. We spend thousands and thousands of dollars for an education and come out knowing nothing? There needs to be a change in this 21st century as to how we teach and train professionals. How often have you heard you use little of what you learned in school? The old apprentice-journeyman system of the crafts probably are more effective.

    June 23, 2011 at 09:13 | Report abuse | Reply
    • unknown

      Medicine employs a journeyman-apprentice based system. It just follows lots of expensive schooling. Basic training doesn't make battle hardened soldiers, but we train soldiers before we send them to work. No matter how you twist it a person will always have that first day on the job.

      June 24, 2011 at 03:03 | Report abuse |
  3. Truth

    Stop trying to cover, there are mistakes being made. I see them first hand, I know that at least once a week a wrong patient is operated on, just corrected before they have an issue. If the docs were not so arrogant and full of overzealous pride, then people would get better treatment.
    Can not wait for the day Watson, MD is finally here.

    June 23, 2011 at 09:15 | Report abuse | Reply
    • NBR

      Once a week? Really – wrong patient or wrong side surgery once a week?
      Don't you have pre-op checklists, time out, etc where you work?

      June 23, 2011 at 11:27 | Report abuse |
    • Jason

      Watson MD doesnt do surgery you freakin idiot

      June 25, 2011 at 11:06 | Report abuse |
    • TM MD

      This might be one of the silliest exaggerations on this forum (which is saying a lot, after having read it all). Once a week the wrong patient is operated on? I work in one of the largest teaching hospitals in the nation, and we don't have anywhere close to that kind of rate of mistakes.

      June 28, 2011 at 12:33 | Report abuse |
  4. No Really ?

    This isn't news. It has been the 'rule of thumb' for decades.

    June 23, 2011 at 09:18 | Report abuse | Reply
  5. Karl

    Education got confused along the way...should be more like the old days of "trade schools" where you learn on the job and move up as you do...after all would you trust a mechanic that spent 4-years studying all the books and yet had never held a wrench?

    June 23, 2011 at 10:29 | Report abuse | Reply
    • unknown

      Either way- you have to pick that wrench up for the first time. Would you rather it be July or another month? I'd prefer someone that just started who at least has education behind them, than someone who just started.

      June 24, 2011 at 02:53 | Report abuse |
  6. combatsportsreview

    When I began Respiratory Therapy school, my insturctor lectured on practice. He explained that medicine was so diverse and infinite, that no one could ever "master" it. Instead you will perpetually "practice" it.

    June 23, 2011 at 10:37 | Report abuse | Reply
    • Crystal

      Very, very true!

      June 24, 2011 at 01:56 | Report abuse |
    • Umer

      leo, era per dire che nfs gi una serie che perde i colpi su tutte le piattaforme, se poi si etnmoto a centellinare anche i poligoni senza sviluppare un sistema di controllo degno del wii, continuer a giocare burnout su pc ed excite truck su wii.

      April 8, 2012 at 22:56 | Report abuse |
  7. Humphry Dumfries

    And, of course, you thanked the nurse, right?

    June 23, 2011 at 13:18 | Report abuse | Reply
  8. Really???

    It took this doctor looking in a book from the pocket of his white coat to realize V fib requires defib. Seems like he needs to go back and remediate ACLS until it's seared in the back of his skull. It also sounds like he should have taken a more pro-active role as a 4rth yr medical student learning what a resident needs to know, before he shows up to assume the job.

    It worked for me.

    June 23, 2011 at 13:27 | Report abuse | Reply
    • Yes, Really

      Self-righteous and arrogant jerks like you are what's wrong with the medical field and doctors these days. No one in my fourth year class spent the last few months of the year doing anything but traveling and enjoying time off.

      June 24, 2011 at 16:04 | Report abuse |
    • Goofing Off?

      @Yes Really: Wait! Are you saying that goofing off for months in medical school is a good thing?

      July 3, 2011 at 12:02 | Report abuse |
    • Guilherme

      Wat telt is de vdinouerhg tussen fytase en fytaatzuur. Als je gaat weken: hoe meer fytase hoe beter, hoe minder fytaatzuur hoe beter. Dat maakt boekweit zo gunstig.In theorie moet je de amandelen kunnen weken, maar ik heb nergens kunnen vinden hoeveel fytase ze bevatten. Nadeel van noten is wel dat ze lang moeten weken vanwege het relatief kleine oppervlak t.o.v. de inhoud. Eerst malen, dan weken zou beter zijn. Neem ook de rauwe amandelen en niet de geroosterde uit de supermarkt. Uit de laatste is alle fytase verdwenen.Een verder nadeel van bakken met meel van amandelen of lijnzaad is het hoge gehalte aan meervoudig onverzadigde vetzuren. Deze oxideren bij hoge temperaturen en zijn dan behoorlijk ongezond.Maar zolang fytaatzuurrijke voeding niet de bulk van je voeding uitmaakt, zou ik mij er niet al te druk over maken. Van elk voedingsmiddel kun je positieve en negatieve eigenschappen vinden. Ik eet af en toe rustig een halve bak geroosterde amandelen, inclusief geoxideerde vetten en fytaatzuur. Optimaal is het niet, maar zolang het niet iedere dag is, geen probleem. Ons lichaam is prima in staat om om te gaan met kleine hoeveelheden antinutriënten. Alleen bij structureel grotere hoeveelheden (zoals een dieet met veel graan) zal het op den duur negatieve effecten hebben.Teveel inzoomen op een negatief aspect van een bepaalde voedingsmiddel doet het al snel ongezond lijken. Amandelen bevatten ook veel goede stoffen zoals magnesium, koper, fosfor, ijzer, zink, vitamine B2, vitamine E, foliumzuur etc...

      February 1, 2012 at 01:09 | Report abuse |
  9. WellnessDrive

    Why only July? Stay out of the hospital at all costs – anytime. Seriously, besides accidents, what can you do to prevent a visit?

    We know many who go on a WellnessDrive. Come and optimize your health. Hopefully you are doing something for prevention to avoid you going to the hospital – unless your visiting someone else.

    June 23, 2011 at 13:49 | Report abuse | Reply
  10. Apul Maa'Deek-Aoud

    WHY do you think they are called 'Practicing Physicians'?

    They're PRACTICING.

    June 23, 2011 at 13:58 | Report abuse | Reply
  11. Kris

    You know I am sure that the situation this doctor encountered was covered in med school but he most likely panicked. Can you imagine what that is like to be an intern and all alone and have someone's life in your hands?

    June 23, 2011 at 17:33 | Report abuse | Reply
    • med student2013

      I completely agree – I just took my boards, USMLE Step 1 and this reminds me of something that a famous pathologist Dr. Edward Goljan said. It was something along the lines of "i know you all know this stuff – you've studied it and you know it like that back of your hand. but you add in a little fear, anxiety, and lack of sleep and things get all jumbled up." It's soo true! When you study diseases and cases in silence where it's only you and your thoughts of course things make so much more sense! It's hard enough choosing the correct answer on a multiple choice question with about 60 seconds to make a decison – I can only imagine having to make a life altering decision in the heat of the moment. I guess that's what I have to look forward to! Throughout med school we are constantly trained to make decisions under pressure and in the end doctors are only human. You can prepare for years for something but in the end people falter and people make mistakes. Even though perfection is expected in medicine, it's not always that cut and dry.

      And yes, thank god for nurses, pharmacists, and the entire healthcare team – that's what checks and balances are for. No need to bash one another, but thank each other for our respective roles and remember the ultimate goal is to save the patient – not our own egos.

      July 22, 2011 at 03:44 | Report abuse |
  12. Marke

    Reason number 1 why you are better off (the majority if the time) at a community, non teaching hospital.

    June 23, 2011 at 23:01 | Report abuse | Reply
    • Jason

      Wrong. Community non-teaching hospitals dont have pediatric neurosurgeons and other highly specialized experts. Community hospitals are fine for general medicine and routine surgeries like appendectomies, but if you want access to the most elite subspecialists, you are going to have to go to a tertiary/academic medical center and deal w/ residents

      June 25, 2011 at 11:09 | Report abuse |
  13. Old Doc

    Medical students, interns, residents, fellows, and attendings all work hard, study constantly, and overall make good decisions. The key concept in medicine is the team approach. Whether it be a peri-operative time out, multi disciplinary rounds on the wards, or grand rounds we all need to work together to provide the best care. The end of the article tell the patient to ask the nurse? Why do we assume the nurse knows anything as well? Use the team approach, practice sound judgement, and do not be afraid to ask questions or ask someone for help.

    June 24, 2011 at 01:15 | Report abuse | Reply
    • JH

      He says ask the nurse, because the nurses USUALLY know more than the interns about taking care of the patients, and I know this from years of experience at a teaching hospital. Those new MDs have a lot of book knowledge, but little clue as to how to apply it in real life – that takes time.

      July 17, 2011 at 12:03 | Report abuse |
  14. checkwitha nurse

    I find it insane to write "make sure they know what they are doing" in reference to the nurse when she just saved his hide and the patients for that matter. The nurses are pretty much making sure the doctors know what they are doing. Nurses dread July!!

    June 24, 2011 at 01:41 | Report abuse | Reply
    • once an intern

      I think the sentence was intented to imply that the patient should check with their nurse to make sure that the nurse thinks the intern is doing his/her job appropriately, not as a jab to imply that the nurse doesn't know what's going on.

      June 24, 2011 at 02:05 | Report abuse |
    • N ope

      ...so do Pharmacists

      June 24, 2011 at 23:21 | Report abuse |
    • Sad

      I am a soon-to-be intern, and all I can say is that we all have to start somewhere. (You had a first day/month also!) And the fact that nurses have already made up their minds to 'dread' us just because of what we are instead trying to get to know who we are is just awful....and counterproductive to patient care.

      June 29, 2011 at 21:36 | Report abuse |
  15. Jimmy Cracorn

    That's seemed like a surprisingly honest portrayal of the medical profession. THANK YOU It's nice to see a honest and reputable doctor for a change. Best wishes in your career.

    June 24, 2011 at 03:24 | Report abuse | Reply
  16. sikorsky69

    i think all the people who are bashing the MDs here are just jealous of their quarter to half-a-million dollar/year income. sorry but MDs studied and trained their as*** off for years so they deserved that.

    June 24, 2011 at 10:49 | Report abuse | Reply
    • JH

      Funny, because MDs in Europe are just as intelligent and qualified and don't make half as much money. Look at the healthcare in places like Sweden, the Netherlands – it is excellent, and their doctors aren't millionaires. Greedy jerks like you brought on the HMOs and the bankruptcy our the US healthcare system.

      July 17, 2011 at 12:08 | Report abuse |
  17. rohan

    after 4 years of medical school..u donno where the heart is!! awesome!!!

    June 25, 2011 at 03:46 | Report abuse | Reply
    • md2015

      the paddles don't go directly over the heart – 1 goes laterally to the heart, the other is on the patient's side. the doctor knows where the heart is, heck a five yr old knows where the heart is, but placing paddles is different.

      July 6, 2011 at 14:58 | Report abuse |
  18. Lynn

    And never go to Duke Hospital! They'll kill you for sure!

    June 25, 2011 at 11:26 | Report abuse | Reply
  19. Jman

    That's why we call it practice.

    June 25, 2011 at 15:12 | Report abuse | Reply
    • Antonio

      Registration will begin April 4th. The camp will run from 9am-4pm. The other information you uteresqed will be on the registration forms. We hope to see your child in the Aquatic Robotics Camp!

      April 9, 2012 at 05:32 | Report abuse |
    • Ali

      when I install vioesrn 1.2.6 it gives me this when I activate it Fatal error: Cannot redeclare catablog_activate() (previously declared in /blog/wp-content/plugins/catablog/catablog.php:37) in /blog/wp-content/plugins/catablog/catablog.php on line 51

      April 14, 2012 at 16:30 | Report abuse |
  20. Sci0n

    this same story ran on BBCNEWS last year....

    June 25, 2011 at 16:16 | Report abuse | Reply
  21. Bill L

    Wow....I am only a second year medical student (3 years less education than the story)...but I sure as hell know where the heart is at and know v-fib is a shock-able rhythm....I am guessing this author barely passed his board exams...or this story is complete B.S.

    June 25, 2011 at 16:47 | Report abuse | Reply
    • rohan

      i knew where the heart was, a long time before i joined medical school... american interns are surely special..i guess!!!

      June 26, 2011 at 00:15 | Report abuse |
    • medgirl

      Clearly you haven't left the classroom yet. May I suggest that you save the article and re-read once you've actually spent a day as a resident. You might feel differently. It's a whole different world when a patient is dying and an entire room is looking at you for guidance. Go easy and you will save lives and gain respect.

      June 27, 2011 at 04:41 | Report abuse |
    • TM MD

      Chill out, med stud. Dr. Youn is a plastic surgeon, which carries an average USMLE Step I score second highest only to my specialty (Dermatology). In other words, saying he probably barely passed his boards is silly and condescending, and anyone who claims to be a medical student should understand why.

      June 28, 2011 at 12:38 | Report abuse |
    • JS

      Knowing where the heart is and what v-fib is the easy part. The hard part is when you are guiding the patient care. After you shock the patient what do you do next? What if it doesn't work? What if it does? Care doesn't stop once you initiate an action, it continues. Internship,residency, and fellowship prepare MD's/DO's for what comes next. We go through medical school to learn the basic, background information and build a foundation for patient care. Residency teaches us how to put that information to use effectively. It also teaches us that there is a lot that we don't know and from this we hopefully gain humility. I think the most dangerous time is when an intern becomes a resident. They know a lot and can take care of most basic and some complex patients but they haven't come to recognize that they don't know everything. To me that is more dangerous than an intern on their first rotation. They have fear and that helps them to be careful.
      I am very thankful for the nurses who were patient with us as interns and helped us learn the ropes. I don't appreciate it when people come onto these forums and pit nurses versus doctors. It is counterproductive and unwelcoming. An MD cannot watch all his patients at once. It is too hard. We rely on good nurses to keep us informed of changing conditions and notify us when we need to intervene sooner than later. I work with some phenomenal nurses and I appreciate the work they do because it can be brutal. They have a skill set that I don't have and vice-versa. Our overall goal of care is the same but the roles we play are different but should be extensions of each other.

      June 29, 2011 at 22:19 | Report abuse |
  22. Newdoc

    People are not born as seasoned doctors or enginneers or anything in any other profession.  Being proficient in anything requires a ton of real life practice not just reading books.  First two years of med school generally doesn't have real world practice and then the final two years is spent bouncing around different fields so it is hard to get a true complete feel for any one area.  Once you are in a field you can focus on that one but that starts with residency.  The author of the article is nice to admit what happened and he was probably full of nerves being the first time anyone had looked at him and expected direction.  It is a whole different thing to lead and tell others what to do than follow instructions.  Props to the nurse who probably had eons of experience with codes in helping the doc out but eventually once real life experience was obtained this MD probably ran codes well.  So his advice is well given and taken.  Anything in life is better done by doing than reading in a book and medicine is no exception.  Wouldn't you want your doctor to have years of experience?  He/she gets that experience by hands on training. There isnt a better way then experiencing the real thing.  Of course there are layers of back up in the hospital, senior residents, attendings so the intern is not the only doc in the house.  

    June 25, 2011 at 18:35 | Report abuse | Reply
    • Farmer/Engineer

      I disagree with you Newdoc. From what I've read so far, many people are born with the innate ability to whine and criticize. Armchair quarterbacks from birth.

      July 15, 2011 at 09:12 | Report abuse |
  23. Sanjaya

    Anthony Youn, M.D., plastic surgeon,
    Thank you for putting forward as an issue to this matter, but it seems that you are covering your weakness and medical skills with the name of all novice interns and residents. People don't born with the degree – MD or phD nor the experience that gains in time, rather we get it through all our life. And being a doctor who else know this better than you. Interns as front line learners to Fellow who are almost expert of the things are also the part of the process and same with their jobs. Errors happens and it shall continue, it can be medication, decision or procedure error. But accepting a true fact that interns are supposed to practice under supervision are never allowed to practice freely. You just bring out a normal event out of the hospital to media to put matters in chaos.

    June 25, 2011 at 21:00 | Report abuse | Reply
    • patient

      If you want your opinion taken seriously and respected, start by learning proper grammar and spelling of our language. Then realize that MD incompetence is no big secret in this country; that's why malpractice rates are so high!

      July 17, 2011 at 12:21 | Report abuse |
  24. Jacob

    Thats right, just tough out that heart attack until August. You'll be better off.

    June 27, 2011 at 09:14 | Report abuse | Reply
  25. DmonMD

    Good thing this guy is out there handling breast implants and not lives.

    June 29, 2011 at 14:21 | Report abuse | Reply
    • JH

      People die from plastic surgery too.

      July 17, 2011 at 12:19 | Report abuse |
  26. Antoinette

    This is why I've always said interns should not be called doctor – they are not until they finish All of the training. Its the only profession that does this. In all others there must be a Licensed person in your field overseeing your Training all the time. INTERNS ARE NOT DOCTORS. THEY ARE STILL STUDENTS AND SHOULD BE ADDRESSED AS SUCH.

    July 4, 2011 at 16:39 | Report abuse | Reply
    • MD

      They ARE licensed. They have every right to be called "Doctor."
      Don't worry about it. You don't have to go to a teaching hospital. Go to a small community hospital without house staff present 24/7. Pat yourself on the back for being smarter than everyone else and avoiding "trainees." You're too stupid to look into outcomes data for house-staff run services vs community practices in non-teaching environments. Enjoy your ignorance.

      July 8, 2011 at 22:44 | Report abuse |
  27. Stone035

    I work in an environment where the team is faced with these decisions. I often speak to the patients who survive about the critical times. Sometimes they remember, sometimes not. Most of them feel comfortable before sedation and intubation when they have hope they will live and their families will be ok. I wonder if the physical trauma is compounded with the emotional trauma of saying goodbye. I for one, am comfortable with the decision for dying with hope. With more time to process what has happened, there is time to prepare and cope with saying goodbye. In trauma, I think it is more merciful to focus on what helps the patient in those last horrific moments.

    July 6, 2011 at 14:13 | Report abuse | Reply
  28. MD

    All the individuals posting about how terrible and greedy doctors are, how they've had it with doctors and the "ruses" they pull, how doctors have god-complexes and in general are just terrible people: PLEASE never come to the hospital or to our offices. We don't want to see you either. Let's all be happy and stay away from each other. We'll take care of the patients who want to see us because we love them and love what we do. They'll come see us because they feel we help them. You guys are a huge pain in that ass, and you clearly hate us, so please... just keep posting your ignorant crap on message boards and stay out of our offices and the hospitals. Everyone wins!

    July 8, 2011 at 22:51 | Report abuse | Reply
    • patient

      Typical MD – considers himself above criticism. It is easier to deny and turn away from the very real issues of patients who are too SCARED to say these things to your face, for fear that you will do exactly what you are doing – abandon them. If you care and love us as much as you say you do, then listen when we say 1) you are charging too much 2) you make us wait too long for a visit 3) you minimize our concerns 4) you don't take the time to explain our condition/treatment options 5) you keep banker's office hours that make it difficult for people with jobs to get appts. 6) you don't have enough support staff to answer phones, etc. Instead keep telling yourself that your patients are smiling because they are satisfied, not because they are just nice people who don't want to offend you.

      July 17, 2011 at 12:34 | Report abuse |
    • MD too

      Dear Patient,

      I understand your concerns and wholeheartedly agree with statements 3, 4, and 6 because before becoming a doctor I was and still am a patient too. Statements 1, 2, & 5 are completely another discussion and are more related to logistics, insurance, keeping the practice (which is also a business) afloat and are frankly out of our hands when it comes to patient care. The entirety of medical care can be frustrating and we can't always fix everything – but we can do our best to have a good bedside manner and to engage as much as we can with the patient in the time that we have to spend with them. Doctors aren't superhumans that can be in a multiple places at once, always be well rested and perky, and be at every beckoning call of the patient when it is a non-life threatening situation. That's what ER's and Urgent Care centers are for – and free clinics for those that don't have insurance. Responses like MD (above) come from being jaded over the years and constantly being run down by long work hours and the years of sacrifice that it takes to be a good doctor. It's sad, but not all doctors are like that (or you may have just caught someone on a long, bad day – because doctors are humans too). It's just nice to be reminded that you're doing something right and worthwhile sometimes, instead of every mistake being blown up and rubbed in your face. I do understand where you're coming from though, but now i hope you have a little more insight to where we are coming from as well.

      July 22, 2011 at 04:17 | Report abuse |
  29. Ng

    The fact of the matter is whether you are fresh on the market as a new md, nurse or whatnot, or you've been one for 20 years.. you will always encounter medical professionals who KNOW what they are doing and those who make wrong decisions and careless acts that can save or kill a patient. It's an individual approach when it comes to common sense combined with knowledge and smarts. Working alonside hundreds of Doctors for years now has lead me to believe that there are very few well rounded professionals out there that I would trust my life in the hands of, and it's unfortunate. Arrogance is a given when working in this field when dealing with life and death..arrogance needs to be avoided. Confidence on the other hand is a necessity and so is practicality. Many physicians I see have little practicality or common sense. Nurses are an obvious asset and just like Dr's there are good and bad..but one thing is for sure, I have seen more nurses save lives then I have Doctors.

    July 13, 2011 at 19:58 | Report abuse | Reply
  30. new intern

    its idiots like this this doctor who don't take their job seriously and are more concerned with getting into the specialty of their choice than in actually being prepared to take care of patients that succeed in the medical world. instead of spending all of my 4th year of med school in doing rotations in my specialty and making connections to get into residency, i actually spent it preparing to take care of patients. i didn't wait until residency to take the classes in advanced cardiac life support, or its equivalents for children and newborns - i did it while in med school and i read the manuals cover to cover. i actually take my role as a doctor seriously. and as a result i've been very prepared, actually knowing what i'm doing once i've started, and easily knowing my limitations and anticipating problems before they happen. and what do i get for it? not matching into my specialty of choice but probably being a better doctor than bozos like this author. these people who dont adequately prepare for patient care also give residents a bad rep by acting like idiots. nurses thought i was a third year and was surprised when they found out i was an intern... interns act like idiots when they should take things more seriously. med schools dont help by not making sure students are well prepared, med students have to be proactive to properly prepare as most med schools wont ensure you're competent by the time you graduate.

    July 16, 2011 at 12:13 | Report abuse | Reply
    • J. Ravadam Patel III, EMT-P, BSN, CRNA, PA-C, DO, FACS, FAANS, MBA, JD

      tiny penis?

      July 16, 2012 at 23:38 | Report abuse |
  31. Ann Jamandre

    You can still get sick in July. The nurses are there

    July 18, 2011 at 13:24 | Report abuse | Reply
  32. doctors are soo stupid... O.M.G....

    let's see what happens to the death rates if we take all of the doctors out of the hospitals for 1 week...

    July 22, 2011 at 04:33 | Report abuse | Reply
  33. Dr Len Kahn

    What happened to the Piggie Back method to quote Dr Chris Barnard the famous heart surgeon ? Why don`t the hospitals adopt the same method ensuring there is an experienced Dr on hand to assist or are we putting cost before care?

    October 26, 2011 at 15:46 | Report abuse | Reply
  34. Kristen Joseph

    You have to be kidding me. I'm a second year medical student and I don't believe its that hard to learn the 2 shockable rhythms. Also, how did this guy graduate with out knowing the difference between the heart and the liver? I'm sure the "July" reference has some relevance, but I'm just wondering what medical school does not teach you these basic things? What ever happened to "first do no harm"? The first thing you learn in medical school is not to do something if you don't know what you are doing. I'm sorry, but this story sounds completely fabricated to me. Perhaps this guy should focus on writing fiction instead of trying to make the american people more afraid of the health care system than they already are.

    November 29, 2011 at 15:02 | Report abuse | Reply
  35. Tinash

    moi, après avoir rsseemblé à un monstre bouffi et cramé (grosses croutes marrons) durant 9 jours, allégée de quelques centaines d'euros, je me demande si le rêve n'est pas plutôt psychologique que réel car je ne vois rien de changé sauf que je sais que c'est ma deuxième peau mais à part cela j'ai toujours mon âge! poudre de perlinpinpin ? autant nous demander de l'argent et ne pas nous faire souffrir !

    February 1, 2012 at 00:27 | Report abuse | Reply
  36. ztupogxbl

    LMsHMI ecqkovbckpdc

    February 3, 2012 at 12:37 | Report abuse | Reply
  37. dqyejjd

    fpZnPP rdfreaocvlvs

    February 6, 2012 at 04:12 | Report abuse | Reply
  38. vasi

    just wanted to point out that you defibrilated the pt, there's a difference between cardioversion and defibrilation.

    February 8, 2012 at 10:10 | Report abuse | Reply
  39. Bar Exam

    Hi there, simply turned into alert to your weblog thru Google, and found that it's really informative. I'm gonna watch out for brussels. I'll appreciate for those who continue this in future. Many people will probably be benefited from your writing. Cheers!

    April 8, 2012 at 00:18 | Report abuse | Reply
  40. A surgeon who wasn't a clueless intern

    This guy is either a master of hyperbole (an Atul Gawande-wannabe who's looking for attention) or was the dumbest intern ever, since I never met an intern (or med student) who had to look up "ventricular fibrillation" in a book to know that the treatment is electrical defibrillation. Very weak.

    November 27, 2012 at 17:28 | Report abuse | Reply
  41. StillKillingEm

    It's not just unfair and unkind to trash doctors this way; it's also naive and simply incorrect. I'm old enough to have seen more than my fair share of incompetent professionals in every career field, not just medicine. But mostly I've seen people striving to do their very best, even in extremely difficult situations. They're human, though, so things sometimes go wrong. A resident almost killed my mother by doing a routine procedure incorrectly. To fix it required late-night emergency surgery, weeks in ICU, and months of recovery. He didn't have to come forward on it, but he did, and he apologized to my mother and her family. He was a wonderful man and a wonderful doctor; he just badly screwed up once. We could have sued him and the hospital, but it would have been evil. To all the critics out there, especially those who, like me, have no medical expertise whatsoever - I wonder how many of us could withstand such high-pressure scrutiny in our own daily job performances and end up with a grade of 100% every day.

    November 27, 2012 at 19:51 | Report abuse | Reply
  42. briandabrain

    With defibrillators all over on many walls in many businesses and work places and even a paramedic knowing about them and there use I am amazed that a trained MD would be that stupid. If this doctor didn't know something as simple and wide spread in use as a defibrillator I never want to run into him in any medical situation.

    December 7, 2012 at 20:33 | Report abuse | Reply
  43. jbrix717

    Ya im sure the nurse is gonna say...no that doctor doesn't know what they're doing....ya right there gonna say he's the best and let him kill you....then they'll move to the next patient as if nothing happened

    July 1, 2013 at 22:45 | Report abuse | Reply
  44. RN

    you treat Vfib with defibrillation not cardioversion......cardioversion is for afib .........even your manual was wrong...dope.......

    July 4, 2013 at 09:19 | Report abuse | Reply
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