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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 2011 study published by the Journal of General Internal Medicine reported a 10% 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 (707 Responses)
  1. Patricia

    Thank you Dr. Youn for your honesty. I've been waiting for this moment since July 1996. My husband had a severe bicycle accident that looked like he was in a motorcycle accident. He had complications and we thought we were in great hands taking him to One of the Top 3 hospitals. We met with an Orthopaedic Surgeon ( supposedly very good) regarding a complicated rotator cuff surgery. The morning of the Surgery we were told the Dr. couldn't make it...mm on vacation..yep lot of Surgical Docs on Vacation in July and that a Senior Resident would do it that day ( & Oh BTW he was leaving for a fellowship next day so he couldn't monitor my husband) The surgery was botched and my husband would go through 2 more surgeries to correct mistakes. My advice general non emergency stuff ok in July. But if you have to have unscheduled surgery DEMAND that the Surgeon-Specialist will be operating no one else. It was crazy in July trying to coordinate his care. I've been telling people since 1996 if you can avoid surgeries in July. Good luck to all

    June 22, 2011 at 17:06 | Report abuse | Reply
    • 30yearRN

      I agree with concerned doc. No way in he** a surgery would be performed here by anyone other than a full-fledged surgeon, no matter what time of year. Our surgeons take vacations all the time (or more likely are out of town at conferences), but they have another board-certified surgeon covering for them. If a particular surgeon is requested, you wait til they are available for non-emergent care.

      June 22, 2011 at 17:27 | Report abuse |
    • MD

      Basically, the way residency is structured in this country is obsolete. It does produce great doctors, no question about it. But we can can also produce superb physicians without having to go through the July effect if the work load is distributed EQUALLY among all residents rather than dumping everything on the juniors the moment they start their training while the seniors hang out in their call rooms because they "did their time." And don't even get me started on some attending physicians at big name medical centers who barely even know the patients they're supposedly following.

      June 22, 2011 at 18:00 | Report abuse |
    • DrPete

      I'm a general and vascular surgeon and this sounds like bunk. At least where I've worked, this kind of thing just wouldn't happen. Never mind the fact that someone who's finishing a residency and going off to fellowship is hardly the brand-new, inexperienced doctor that this article is talking about.

      June 22, 2011 at 18:01 | Report abuse |
    • MD

      However, I must add, Patricia, what you said is utter nonesense. What you described simply doesn't happen in this country. You were either in Canada or there was some sort of misunderstanding.

      June 22, 2011 at 18:03 | Report abuse |
    • Lanfear

      Oh get off your high horses, Drs. However unlikely it may sound to you, do you really think Patricia has some hidden agenda that she needed to come here and make that up? Quit trying to save face.
      By the way, it's been my experience that Drs aren't always the expert they think they are. Just thought I'd throw that in there.

      June 22, 2011 at 18:13 | Report abuse |
    • MD

      Then don't go to doctors. Go to chiropractors and acupuncturists and get your expert care there.

      June 22, 2011 at 18:17 | Report abuse |
    • medical student

      I agree with what the two doctors said. While my surgical experience is limited to several-week rotations in surgery and obgyn, not once did I sit in on a surgery that wasn't being supervised by an attending-physician. In the one instance where I assisted a surgeon performing two operations in two ORs, our team didn't proceed with the procedure until it was being done under the guidance of our attending.

      June 22, 2011 at 18:26 | Report abuse |
    • jonno

      uhh, yeah, also as a current externing medical student, I have never seen a surgery performed without the direct supervision of the attending physician. Also, if a "new" Resident is in on the case, 99% of the time they begin by putting their time in retracting for the attending until they earn their confidence, and when they do take the lead, they are supervised extremely closely.

      June 22, 2011 at 18:40 | Report abuse |
    • tlbkcal

      @ MD and the rest of the Drs, this is classical medical doctor arrogance. Even if there is a 0.0001% chance that Patricia can be correct, you have to acknowledge that. In any case, I was told by a neurosurgeon that I HAD to get microdiscectomy for my 15mm ruptured disc. I went to a chiropractor instead and after 30 treatments I almost completely recovered. And don't get me started about placebo effect because if I can regain range of motion, mobility, and elminate sciatica just because of "placebo effect" then give me more of that placebo! And all this is coming from an engineer in the pharma/med device industry who makes a living off of surgical instruments so can't say I am biased due to profession.

      June 22, 2011 at 18:40 | Report abuse |
    • jonno

      ok 'engineer in the pharma/med device industry', follow one of your reps into the OR for a month and report back to us how many times you went in to the scheduled surgery only to find out the scheduled surgeon had decided to take a vacation.
      Do mistakes happen in surgery? Of course, but don't start a 15 year agenda based on one experience.

      June 22, 2011 at 18:44 | Report abuse |
    • phil

      @ all the doctors commenting on here

      Okay then, Doctors... Why after having a doctor care for my father for 20 years did he not notice that he was going in renal failure? He checked him once a week during the past 3 years. It ultimately lead to us recommending dialysis, to which he replied "I never thought of that". He was on dialysis for about 1 week, then died. Why did the doctor not notice this earlier? Why did he keep adjusting diuretics instead of finding the root cause of the water retention?

      Doctors make mistakes and look past things. Even good, very experienced ones. Surgeries do get botched. Clamps and sponges get left in the patient... Generally, _hit happens and life goes on.

      June 22, 2011 at 18:45 | Report abuse |
    • MD

      It takes one single blood test to determine that your father is in renal failure. I find it hard to believe that his doctors checked him once a week for three years and never did a basic metabolic panel. If so, that would be malpractice.

      June 22, 2011 at 18:48 | Report abuse |
    • tlbkcal

      Drs, that's precisely our point. We understand your work is important and the overwhelming majority of the time it's beneficial to patients and society. However, do not dismiss Patricia's comments and "stupid" and "unbelievable" when it's just based on YOUR own experiences. Most of the comments from doctors here are along the lines of "I've never seen it, therefore it's not possible." Get over yourselves and your own experiences for a minute and realize and acknowledge that mistakes DO happen and there is a possibility a resident can be asked to perform surgery in place of a surgeon on vacation.

      June 22, 2011 at 18:55 | Report abuse |
    • tlbkcal

      and = as. For those grammar trolls.

      June 22, 2011 at 18:56 | Report abuse |
    • Edwin

      Since there seems to be a debate about the expertise of doctors, I thought I would chime in. My wife has allergies to several antibiotics, and she has had an anaphylactic reaction to medication before. Yet I cannot tell you the number of times that a physician has prescribed a medicine for her on her allergy list (which they had available, as well as her medical history about the allergies). Never simply trust that a doctor is always right - ALWAYS be your own advocate, even to the point of sounding foolish.

      June 22, 2011 at 19:01 | Report abuse |
    • jonno

      ok tlbkcab, it is possible. It is also possible that that an invisible water troll teleported into the operating room that day and temporarilly knocked out all the staff, then became visible, then shrunk to the size of a peanut and walked inside the shoulder. Said water troll has since lived inside the shoulder causing problems. And don't you try to tell me it's not possible just because you've never seen it happen.

      June 22, 2011 at 19:04 | Report abuse |
    • tlbkcal

      Jonno, please tell me you're not a medical doctor and if you are please tell me which hospital you work at so we can do everyone here on this forum a favor to avoid you at all costs. If I was a medical doctor, I would be embarrassed that a colleague of mine made such a comment.

      June 22, 2011 at 19:24 | Report abuse |
    • tlbkcal

      Oh, you're still a student. That explains it. All is forgiven. Doctors and nurses, you got your hands full with this one when he comes out. I'm sure he's a smart kid though.

      June 22, 2011 at 19:31 | Report abuse |
    • jonno

      tlbkcal, ignorance of water trolls is one of the leading causes of heart disease.

      June 22, 2011 at 19:35 | Report abuse |
    • Daniel

      To the MD: Instead of getting defensive with a patient and telling them to go to a chiropractor you should hold a higher ground and LISTEN to what a patient is saying. Drop your ego so that you may see!

      Is the U.S. healthcare system infallible and free of error? Then why are you suggesting that these kinds of mistakes only happen in Canada or other countries? Jeez, I would hate to be under your care.

      June 22, 2011 at 20:27 | Report abuse |
    • Imadoc

      @tlbkcal – how bout you guys try listening to US and not the charletans who practice "alternative medicine"
      @Edwin – Nausea and vomiting are NOT allergies...they are side effects...completely different. An allergy is if someone's throat closes shut. When we see someone who has an allergy to everything under the sun it usually means one of two things: 1. they're crazy or 2. they're trying to get pain medicine from us to either get high and forget about their own life or to sell. It's actually a way for us to screen normal patients from crazy ones.
      back to @tlbkcal – did you actually do the research and find the article that showed no difference between going to an MD, chiropractor, or doing nothing for back pain? Did you read that after 6mo to 1 year all back pain gets better? Did you see that most normal individuals who have herniated discs have NO pain whatsoever?
      WE'RE NOT ON OUR HIGH HORSES HERE, PEOPLE...WE'RE SIMPLY PRACTICING OUR TRADE THAT COST US 12-20 YEARS TO LEARN PLUS $200,000 TO OBTAIN. For the love of God, trust us that we know what we're talking about.

      June 23, 2011 at 00:05 | Report abuse |
    • GasMD

      @tlbkcal

      "Drs, that's precisely our point. We understand your work is important and the overwhelming majority of the time it's beneficial to patients and society. However, do not dismiss Patricia's comments and "stupid" and "unbelievable" when it's just based on YOUR own experiences. Most of the comments from doctors here are along the lines of "I've never seen it, therefore it's not possible." Get over yourselves and your own experiences for a minute and realize and acknowledge that mistakes DO happen and there is a possibility a resident can be asked to perform surgery in place of a surgeon on vacation."

      The doctors here aren't contending that we don't make mistakes. What is absurd to us about Patricia's story is that the resident doing the surgery by himself. There has to be direct supervision by an attending in all surgeries. The teaching hospital would lose accreditation. This is why the story is absurd. It just doesn't happen.

      June 23, 2011 at 18:20 | Report abuse |
  2. Patricia

    BTW that was one of the TOP 3 Boston Hospitals ty

    June 22, 2011 at 17:07 | Report abuse | Reply
    • 30yearRN

      Sorry, not buying it.

      June 22, 2011 at 17:28 | Report abuse |
    • Ravi

      Patricia,

      The establishment will never "buy" it, though we all have experienced such things routinely. Which is perhaps why a 100,000 patients die of preventable hospital induced causes. If only they wake up and see the reality.

      June 22, 2011 at 18:13 | Report abuse |
    • Paul

      Doctors aren't doctors anymore in this country. They are just living for more insurance payments. They don't wait to answer more questions from the patients. They always want to go out of the room quickly thinking their ruse might got. I've had it with doctors here. The number of MRSA and nosocomial incidents are on the rise and it is alarming how many patients die every year either due to doctors mistakes or hospital based infections. We need to each subpoena a public record from each hospital in the country. I believe this would have happened to you and your husband, Patricia.

      June 22, 2011 at 18:30 | Report abuse |
    • Edwin

      Paul,

      Not all doctors are like that. Most of the doctors my family has seen have been very caring, concerned individuals. Some still made mistakes, though, which is why you have to be alert.

      June 22, 2011 at 19:12 | Report abuse |
    • Imadoc

      @Paul – perhaps we wouldn't have to see so many patients in such little time if we were actually reimbursed the appropriate amount. What's funny is that you probably didn't know that the largest denier of claims is The U.S. Government (Medicare and Medicaid)...that same body that you feel is going to be the savior by providing "free" medical care to everyone. We want to order a test...they say no. We want to prescribe this drug because it has less side effects...they say no. We want to do such-and-such procedure because it will help people get back to work...they say no. If doctors don't get paid and thus cannot pay off their medical school debt, no one will go into medicine.

      June 23, 2011 at 00:29 | Report abuse |
  3. FELIPE

    I wonder what brand of O2 mask is the one you squeeze and please throw away that book that taught you that you cardiovert a VF patient...

    June 22, 2011 at 17:10 | Report abuse | Reply
    • Jim

      It's called a bag mask. Also, please take ACLS again. You shock VF.

      June 22, 2011 at 17:22 | Report abuse |
    • SoTrue

      I was thinking the same thing,,,,, clearly plastic surgeons should stick to boobs and not ACLS.

      June 22, 2011 at 17:26 | Report abuse |
    • SoTrue

      You do not cardiovert, you defibrillate VF, DUUUH

      June 22, 2011 at 17:27 | Report abuse |
    • SurRy

      Oh dear. Doesn't know the difference between cardioversion and defibrillation?

      June 22, 2011 at 17:53 | Report abuse |
    • HopkinsRN

      I think that some of the awkward terminology results from writing an article for a lay audience. The term "cardioversion" seems to refer to shocking in the general sense rather than to mean synchronized cardioversion which I'm assuming is your complaint. Ditto to "oxygen mask." I'm guessing that most who read this article know what the author intended. Bravo to a surgeon who can laugh at himself!

      June 22, 2011 at 17:57 | Report abuse |
    • MD

      car·di·o·ver·sion
         [kahr-dee-oh-vur-zhuhn, -shuhn]
      –noun Medicine/Medical
      restoring the rhythm of the heart to normal by applying direct-current electrical shock.

      The general term cardioversion can be used to encompass defibrillation, although SYNCHRONIZED cardioversion refers to a different procedure. Learn some English before criticizing the author.

      June 22, 2011 at 18:28 | Report abuse |
    • JH

      MD is right. The author is addressing a lay audience, who probably doesn't know what a "bag mask" is. Back off, people, it's a humorous blog!

      July 17, 2011 at 15:33 | Report abuse |
  4. Don_J

    ...if the Republicans have their way you'd better hope you never get sick and need a hospital.

    June 22, 2011 at 17:11 | Report abuse | Reply
    • Jose

      Ok im a lib. but what the F did this have to do with politics. Quit hating!

      June 22, 2011 at 17:23 | Report abuse |
    • Total nonsense

      let's hope yu got really sick in Jully, with any luck... there will be one less idiot on earth

      June 22, 2011 at 18:13 | Report abuse |
    • Edwin

      Good one, Jose. I agree 100%.

      June 22, 2011 at 19:14 | Report abuse |
  5. Rodrigo

    Kudos to the nurse who knows what the right thing to do! They are the unsung heroes, underpaid, overworked, and sometimes unappreciated! Truly patient advocates!

    June 22, 2011 at 17:13 | Report abuse | Reply
    • james

      bravo nurses!!

      June 22, 2011 at 17:16 | Report abuse |
    • Calibri

      Yes huzzah nurses, but my friend is a nurse and she shows just as little respect for interns (M.D.) as doctors supposedly do for nurses.

      June 22, 2011 at 17:42 | Report abuse |
    • jonno

      underpaid? overworked? Geeze, you make it sound like their jobs are so miserable.. Nurses are compensated quite well actually and nursing is an awesome field to go into.

      June 22, 2011 at 17:49 | Report abuse |
    • MD

      And that's precisely why when interns become attending physicians they disrespect the nurses who disrespected them when they were interns.

      June 22, 2011 at 17:55 | Report abuse |
    • SurRy

      Jonno, it is clear you are not a nurse who has stood at the bedside of a post-op surgical patient who has spent 12 hours trying to die on you.

      June 22, 2011 at 17:56 | Report abuse |
    • jonno

      SurRY – No, I am not a nurse, but my wife is. And, as we have had to move each of the last 3 years, she has had 3 different nursing positions, in 3 different fields each of the last 3 years – straight out of school, and one of them was on a post-surgical floor, and currently as an OR nurse. She has been paid extremely well, and yes, in certain positions/units, the work can be hard, but she loves her work. If you feel you are worked too hard, you can easily switch positions... but if you are standing by the bedside for 12 hours helping save a patient's life, I have a feeling you love your job as well.

      June 22, 2011 at 18:32 | Report abuse |
    • Bonnie

      I agree. You want to know what a Dr. should be doing? Ask a seasoned nurse!!

      June 22, 2011 at 18:37 | Report abuse |
    • RT

      Its funny how all I hear in this article and replies are nurses. That third person sitting at the head of the bed using the bag mask is called a Respiratory therapist, which at most hospitals at least in Canada can and is responsible to intubate during a code. Most nurses at least at my hospital at 2 in the morning are so much happier to see an RT come running into the room than any resident.

      July 3, 2014 at 14:17 | Report abuse |
  6. Dave

    I have never seen a nurse ask a doctor what to do during a code. They always jump into action until the code team arrives.

    June 22, 2011 at 17:14 | Report abuse | Reply
    • 40 year RN

      Perhaps the nurses needing direction were just out of school themselves – they graduate at the same time of year. Nurses also do not come out of school knowing everything – it takes them at least 6 months! 🙂

      June 22, 2011 at 17:54 | Report abuse |
    • tapuhere

      Yeah, I rolled my eyes when it said the nurse asked, "What should we do, doctor?" Please.

      June 22, 2011 at 18:05 | Report abuse |
  7. Fiona

    How reassuring.

    Maybe there is a problem with the way new interns are rotated in en masse? Just a thought.

    June 22, 2011 at 17:15 | Report abuse | Reply
  8. Nassir

    As comical as the story is presented, it is hard to believe that the nurses would not have seen VF before and would not have known what to do in the scenario.

    June 22, 2011 at 17:16 | Report abuse | Reply
    • JH

      They KNOW what to do...they are just not legally ALLOWED to do it!

      July 17, 2011 at 15:44 | Report abuse |
  9. Scott

    Having just left a hospital this week, I can without question say that the best way to avoid being injured in the hospital is to be an active patient and/or have someone close to you that can be an active patient for you. The rush to get things done by the staff coupled with the extremely slow communication between nurses and residents often results in mistakes or missed opportunities. This would be especially true w/ new residents that are not knowledgeable of the way their specific hospital works. I value the doctors and nurses, but at the end of the day it is on you the patient to be involved. It's just the way hospitals work.

    June 22, 2011 at 17:21 | Report abuse | Reply
    • Dee

      I thoroughly agree. I am 5 weeks past abdominal surgery; everything went very well. I had great care. But there was a point where one of my post-op pain meds wasn't working well and a nurse said, "No problem, we'll get Drug X for you." If I hadn't shouted STOP (along my with my friend who was staying with me), she would have given me Drug X, for which I had a noted/charted allergy. I would like to think surely she would have double checked my chart first...but just in case, it behooves patients to ask questions, respectfully, and be quick to speak if they think something isn't right or isn't being heard.

      June 22, 2011 at 17:47 | Report abuse |
    • JH

      She would have checked your chart first, and she would also have to call the MD for an order first, so your worry is premature.

      July 17, 2011 at 15:55 | Report abuse |
  10. Trav0

    You know what else can kill you? Not going to the hospital if you have a life threatening condition.

    June 22, 2011 at 17:22 | Report abuse | Reply
    • tapuhere

      Ha! Very good point.

      June 22, 2011 at 18:06 | Report abuse |
  11. hello

    Many nurses are ACLS certified and run codes even though residents are there, who are often not ACLS certified. The nurses will run the code until an attending is able to arrive.

    June 22, 2011 at 17:30 | Report abuse | Reply
    • SurRy

      I recall the first-year surgical resident who almost defibrillated unstable rapid a-fib, the emergency medicine resident who almost let go of the guide wire of the triple lumen, and the critical care medicine fellow who demanded that a neosynephrine drip be started at about 20X the correct rate. Thank goodness a well educated and well trained registered nurse was there to say "Stop!" Everyone needs to recognize that all the players are valuable. Like they tell the newbies, "ignore the nurses at your peril."

      June 22, 2011 at 18:08 | Report abuse |
    • jonno

      Wow, SurRY, somebody needs to get off their high horse.

      Do nurses come right out of school mistake-free? As a nurse for who knows how many years, you are so proud to tell of the mistakes you've seen new doctors make – I bet you've never corrected new nurses from such errors. From my experience as a medical student, I can tell you the vast majority of the doctors I have worked with are extremely grateful to the nurses, and as a student, I seek guidance on the floor from veteran nurses just as often as I do from veteran doctors. But just like certain doctors may snap at me for asking stupid questions, there are always certain nurses that roll their eyes that a medical student/resident wouldn't know "that a neosynephrine drip shouldn't be started at about 20X the correct rate". Maybe it's time to get over yourself.

      June 22, 2011 at 18:58 | Report abuse |
    • Imadoc

      It's funny SurRy...they told me "trust the nurses at your peril"...hmmm I agree with jonno in that you should get off your high-horse. There's a reason that there's a hierarchy in medicine. Everyone should know their role and the role of nurses is to do what they are told – to a degree. If you notice that someone is ordering a drip at 20x's the rate, then yes, correct them, but if it's simple things (as I've seen all too often) that you disagree with, as questions first before assuming that the intern/resident/fellow is wrong.

      June 23, 2011 at 00:38 | Report abuse |
  12. Paula

    As a nurse for 45 years, I have told friends not to go to the hospital in July for this very reason. July brings us lots of newbies with great educations, but no practical knowledge and few clinical skills. Peggy Anderson wrote a book called Nurses Keep You Alive, Doctors Don't back in the early 1960's that described this well. ( still in print I think) Things have not changed low these many years. We (nurses) patiently teach, support, suggest and cajole our newbies for the first few years of their residencies, keeping them out of trouble and guiding them through the maze of patient care. And low and behold in a few years we have experienced, knowledgeable, skilled and competent physicians. We rarely get any credit for our efforts, but we know and smile at the results.

    June 22, 2011 at 17:30 | Report abuse | Reply
    • dan

      try not to fall off your high horse. nurses are great but they are the panacea that so many people (mostly nurses) think they are. things have changed in the last 45yrs but when people who have been around too long are unwilling to accept it or notice it, it may seem that they havent. and if you are still having to teach your residents while they are in the first few years of their residencies, you need to either change hospitals or switch to a surgical floor. and i think underpaid, underappreciated, and overworked describes residents better than it does nurses.

      June 22, 2011 at 17:47 | Report abuse |
    • Imadoc

      Paula, one of the things I loathed most during residency was when the nurse would say "I'll be your advocate" as if the doctor was chopped liver. I would then, in front of the patient...right before they went to sleep...say to them, "but I'll be the one keeping your alive". We need to get over this "I'm-better-than-you" mentality that far too many nurses have. They have a chip on their shoulders for some reason. If I had listened to the nurses during my intern year at a major academic teaching hospital I would have had WAY too many innocent deaths. Instead, I used my "peripheral brain", which many here seem to condemn because they think we should have all the information in our head by that time, and found the nurse to be extremely off base. Doctors, not nurses (because they can fall back on the doctor's license) are the only professionals who are expected to be perfect at all times every day, and when we're not we're called stupid or we're questioned for our intelligence or motives. That's bull-poop. If nurses are the ones keeping patients alive, then why don't they take on their own liability instead of hiding behind that of the M.D.?

      June 23, 2011 at 00:46 | Report abuse |
  13. Linda S.

    The article was interesting, but the comments were more interesting. I, personally never heard of the July Effect. Nonetheless, as an EMT (15 years worth), we all have to start somewhere and I remember my neophyte days, terror stricken, fresh out of school, going blank, but also the exhilliration of the learning curve, my unbridled enthusiasm and patience of my fellow EMTs in helping me "break through". Everyone connected in health care, the job can be trying, scary and exciting. Respect anyone in a position to do good for you: interns, emts, paramedics, nurses, because they went into the field to help you. Everyone first starting out will be new and nervous, that's normal. If, as a patient, you think that your health care professional is not cutting it, ask to speak to a supervisor.

    June 22, 2011 at 17:31 | Report abuse | Reply
  14. Sharky

    Doctors are cool.

    June 22, 2011 at 17:32 | Report abuse | Reply
  15. sitzbath

    geez can't people people inflate their egos by putting down their young trainees and producing doubt about the legitamacy of our medical education system without ridicule anymore? I mean seriously people, plastic surgeons have insecurities too

    June 22, 2011 at 17:32 | Report abuse | Reply
  16. New Intern

    "Thank God for these manuals. Otherwise I would have been part of “The July Effect.”"

    I like how your disparage all new interns for "not knowing what they're doing" and running around causing all these patient deaths then absolve yourself of being part of the experience. "They're all idiots... except me".

    As was mentioned before, you're quoting one study and one study alone. There's also a great study in JACS earlier this year showing that having residents involved in your care is actually slightly PROTECTIVE against mortality.

    The simple truth is that there is never more oversight of resident actions than in July. Interns page more because they know their limitations and seniors are more tolerant of silly and not-so-silly questions. Attendings follow their patients more closely because the chiefs are new. As patient, you do not have to worry about an intern "killing you" because you are in the hospital in July. The hierarchy is in place for a reason. If anything, late in the year tends to be more harrowing. Junior residents have collected some knowledge and have more difficulty recognizing when they're in over their heads. Chiefs tend to let the juniors handle more responsibility and are more resistant to being paged about smaller issues. Plus many are checked out as they look forward to fellowship or their new job. Attendings are more comfortable letting the chiefs handle things since they are "essentially attendings."

    June 22, 2011 at 17:35 | Report abuse | Reply
  17. rdp

    really? u want to cardiovert a VF pt?

    June 22, 2011 at 17:35 | Report abuse | Reply
  18. Erik V

    Ok, now I'm nervous. I have surgery in july!!!! A laparoscopic appendectomy, should I be worried?

    June 22, 2011 at 17:37 | Report abuse | Reply
    • sharbe

      Only if you are going to a teaching hospital. If you have a competent surgeon that doesn't train other surgeons, you will be fine. It's the teaching hospitals that have the new residents on staff in July.

      June 22, 2011 at 18:03 | Report abuse |
    • emdoc

      No, the attending physician will be doing the surgery. If an intern is even in the operating room in July, they won't be doing much more than holding the camera.

      June 23, 2011 at 02:57 | Report abuse |
  19. M4

    My kingdom for a person leaving a comment who actually has a sense of humor.

    June 22, 2011 at 17:37 | Report abuse | Reply
    • tapuhere

      This couldn't be more true! I had neurosurgery last July, and I died.

      June 22, 2011 at 18:11 | Report abuse |
    • SoS

      How about a horse instead?

      June 22, 2011 at 18:53 | Report abuse |
  20. m

    Gimme a break. This guy didn't know where the heart was in relation to the liver? Not only is he not qualified to practice with instruments, they ought to take his keyboard away from him because he's using it to lie. Regular life teaches you where the heart is located. You don't need no stinking medical school for that. As far as the liver is concerned, they call it the "liver" because if you don't have one you're a "dier." Seriously, how can you publish this rubbish?

    June 22, 2011 at 17:40 | Report abuse | Reply
    • ICare

      He knew where the heart was! He was just so panicked that he didn't pay close attention to his positioning of the paddles, that's all. It wasn't lack of knowledge, it was lack of hands-on experience.

      July 17, 2011 at 16:08 | Report abuse |
  21. dan

    A recent study of surgical residents showed that there is no "July Effect." While there are more minor errors in the early days due to inexperience, there are more complications in april, may and june bc residents are given more freedom to practice. There is very close supervision of new residents in the early months so please dont believe in the myth of the july effect. Maybe it was true in the "good ole days" but we are all closely supervised now.

    June 22, 2011 at 17:40 | Report abuse | Reply
  22. carol

    If you do have to go to a hospital, choose one that isn't a teaching hospital, this type normally doesnt' have medical students and/or residents...you never know, it could save your life.

    I've seen 4th year residents still making stupid mistakes and they're finsihing their residency....still called doctor whether you graduate 1st or last...

    June 22, 2011 at 17:40 | Report abuse | Reply
  23. Devil's Advocate

    I'm an orthopaedic surgery resident and have to be honest on this point. I find it horribly frustrating when a patient comes to an academic hospital and asserts that only the attending surgeon must do any part of the operation. How do you think medical students turn in to residents and residents in to full fledged doctors? There isn't a magical day when we finish residency that means we know everything. It takes those 3-11 years of experience to build up that experience and why we are supervised during this time. Particularly in a field like surgery, hands on experience is critical to future patient care. If you do not want "trainees" (i.e. residents) involved in your care, then please seek care in a private hospital that does not focus on training the next group of physicians.

    With that said, please understand that I do not endorse residents practicing and operating with direct supervision of an attending surgeon. However, when you have an attending whose an export in the field peering over your shoulder and telling you when and where to stop, mistakes are quite uncommon. Remember, what you value in a surgeon is not their technical skills...a technician can be trained for that. It's their judgement, and that judgement is present whether they are directly hands on or hands off and watching closely.

    June 22, 2011 at 17:45 | Report abuse | Reply
  24. Jahari

    Once I transported a friend to the hospital for a medical emergency. She was prescribed a med and when she asked the doc about the side effects he told her to ask the nurse and i quote him now "she will know more about that stuff than I do." So kudos to nurses who do a lot of work and get not as much credit. But just to be fair I have so wonderful doctors. And one told me about 20 years ago that July is not to month to check into the a hospital if you can at all avoid it.

    June 22, 2011 at 17:48 | Report abuse | Reply
    • New Intern

      These nurses have been doing their jobs for years while residents are fairly new at it. It is always a good idea to trust in the knowledge of the nurses. I know as an intern i very much appreciate all of the nurses I work with.

      June 22, 2011 at 18:00 | Report abuse |
  25. New Intern

    I am a new intern who just graduated from one of the top medical schools in the nation. And still, I feel completely dumb when it comes to practicing medicine alone. This is not a problem though because the ACGME has recently revamped most of the rules regarding resident education. We are not allowed to do anything except the most basic things (H & P, start an IV, etc.) without direct supervision from an attending physician. The new duty hour rules however good they may sound, are not good though. As a surgery resident we no longer take call and have post-call plus a full day off. Because of the new rules, I and my colleagues will have to work 6 days a week for almost 5 years.

    June 22, 2011 at 17:59 | Report abuse | Reply
    • emdoc

      The 16hr work limit is just for interns. You'll still have 24+ hour call with post-call days after that.

      June 23, 2011 at 03:01 | Report abuse |
  26. Gary

    Cardioversion for VF arrest Doctor? I think you should have consulted somebody before posting this article on CNN, you never cardiovert VF, you always shock it!!

    June 22, 2011 at 18:00 | Report abuse | Reply
    • New Intern

      I was thinking the same thing...maybe cardioversion for unstable V-Tach, but definitely not V-Fib.

      June 22, 2011 at 18:04 | Report abuse |
    • emdoc

      cardioversion = shock. synchronized cardioversion = synchronized shock

      June 23, 2011 at 03:02 | Report abuse |
  27. sharbe

    And pray you have some seasoned Paramedics in the ER that know how to handle all types of emergencies. I have pulled more than one doctor's and nurse's butts out of the ringer because they didn't have enough on hands training. But medics are treated like we have the scourge when it comes to salaries because we didn't attend college as long to earn an MD or RN degree. Funny how that works!

    June 22, 2011 at 18:01 | Report abuse | Reply
    • Brantz

      Blah Blah Blah.

      June 22, 2011 at 21:07 | Report abuse |
  28. Armold

    "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."

    Don't you think this is lopsided doctor? You're in effect saying that patients have to respect new doctors but to always check on every nurse to see if they know what they are doing. You're just like all doctors...EGOMANIACS!

    June 22, 2011 at 18:04 | Report abuse | Reply
    • Paul

      I think he went to check with the Nurse to make certain the Doctor knows what the Doctor is doing.

      June 22, 2011 at 18:11 | Report abuse |
    • sitzbath

      here's an idea: learn to read before spouting off another one of your petty rants

      June 22, 2011 at 18:13 | Report abuse |
    • js

      He meant "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 [the interns] know what they’re [the interns] doing."

      June 22, 2011 at 18:22 | Report abuse |
  29. Vicki Donavenn

    If you are looking for the right job in the US visit jobfitter . gu . ma to be matched with the best jobs for you!

    June 22, 2011 at 18:05 | Report abuse | Reply
  30. Bill

    Thanks for your honesty. There are nurses who have worked in speciality fields for decades and know more than the doctors.
    When you work for decades with patients you learn little nuances and subtle things that cannot be taught in the classroom.
    I cannot describe what I am talking about but there is a certain 'ebb and flow' with patients, where your treatment of patients is not based of classroom knowledge but experience and certain intuitive feelings you get from the years of experience. Also, you learn that just having knowledge isn't enough, it is the trust the patient has in you based on the concern you have for the patient.

    June 22, 2011 at 18:06 | Report abuse | Reply
  31. CJ

    Technically defibrillation is called unsynchronized cardioversion, you people sure do nit pick.

    June 22, 2011 at 18:08 | Report abuse | Reply
  32. Guest

    My husband died in less than 2 hours after walking into the emergency room on July 30th. I could tell the doctor didn't know what the hell he was doing and after all that and we requested a autopsy because my husband had no history of heart disease, the hospital told the coroner's office that my husband did not have a primary doctor which was a lie and the coroner did not do an autopsy but kept his body for 5 days. DON'T GO TO A HOSPITAL IN JULY!

    June 22, 2011 at 18:08 | Report abuse | Reply
  33. John Smith

    Doctors and nurses view patients as nothing more than meat – in their opinion, patients should lie in pain quietly, never hit the call button, never ask questions of the doctors or look them in the eyes...You get more respect from your mechanic or plumber than you do from your doctor. Why? Because they need YOU for repeat business, word of mouth referrals...Doctors and nurses don't give a sh!t about that – you're in their world, a prisoner. Don't like your "service"? Go find another hospital...yeah, right!

    June 22, 2011 at 18:11 | Report abuse | Reply
    • js

      Yes, if that is your experience you should find a new hospital. That is not how we treat patients where I work.

      June 22, 2011 at 18:25 | Report abuse |
    • JH

      Check out this website: Vitals.com

      It gives the patients a chance to rate their doctors and describe their experiences. I wish everyone was required to comment on it after every visit to every doctor – then we might get an accurate picture of who the good ones are instead of spinning a roulette wheel every time!

      July 17, 2011 at 16:29 | Report abuse |
  34. bannana

    What is ths non-sense? What hospital uses hand paddles, and who cardioverts v-fib...and when do nurses ask what to do in a code. An ER physician might order some extra drips or Amio drip but for the love of god-why is this ignorant nonsense being published. Nurses and doctors are both good proffesionals that are overworked, however only nurses are underpaid-way underpaid. The truth is that nursing schools spread propaganda that there is nursing shortag and that nursing is lucrative–both untrue. Very dissapointed with CNN on this one.

    June 22, 2011 at 18:11 | Report abuse | Reply
    • JH

      There is a nursing shortage – if you want to work evening or night shift and never see your family, or as a float nurse where you never know what kind of unit you will be working at from one day to the next.

      Lucrative? I know some hairdressers who make more than nurses.

      July 17, 2011 at 16:32 | Report abuse |
  35. tapuhere

    I was a nurse for over 75 years and I never once saw an intern wash their hands. They don't wear pants, either. I wouldn't let them come near me.

    June 22, 2011 at 18:13 | Report abuse | Reply
    • tapuhere

      Hey, M4, that was for you! >:-)

      June 22, 2011 at 18:14 | Report abuse |
    • sitzbath

      they also eat without utensils and wipe without toilet paper

      June 22, 2011 at 18:15 | Report abuse |
    • Andrew

      You were a nurse for 75 years? Are you like 95? That's something.

      June 22, 2011 at 18:34 | Report abuse |
    • tapuhere

      you know that was a joke, right, andrew?

      June 22, 2011 at 19:06 | Report abuse |
    • Donna

      LMAO!!

      June 22, 2011 at 21:07 | Report abuse |
  36. Wendy2206

    So, July each year is not OK to go to the hospital, but 4 weeks later in August IS OK?
    Do the interns really learn that much in 4 weeks to make the statistics different?

    Also, I must say in defense of the interns and overall medical profession, human beings do make mistakes and it is difficult to uphold the expectations of the public in the medical field. Nobody is perfect. Making a human mistake at a desk job may not cost a life like making a medical mistake. However, I suppose those who choose the medical profession are aware of this and what they're getting into?

    June 22, 2011 at 18:15 | Report abuse | Reply
    • js

      He didn't actually cite any statistics, just folklore, no data.

      But the learning curve is very steep and interns learn a lot in the first 4 weeks.

      June 22, 2011 at 18:27 | Report abuse |
  37. Marcia

    My husband went to a very good hospital under the care of a very respected urologist for a routine TURP operation (in and out in a short time). The date was July 22. He chose to have his resident do it. She punctured his urethra, collapsed his bladder and the solution which was in his Foley catheter managed to circulate ithrough his peritoneal cavity filling him full of fluid until he looked like a woman 8 months pregnant in recovery. His gut also locked up for a short time. He got a major infection and spent one month in bed. He was in shock with his electrolytes crashing in the recovery room 7 hours after the surgery before they decided to go back and redo the catheter. We were never informed the intern did it, and he was not placed in ICU. There was a major cover-up and we were never given either an explanation or an apology. I do not know for sure if the surgeon was in the room for the surgery. He is alive today because all of the rest of the staff was awake and alert. We got the records and saw that our surgeon did not do the surgery. My husband is a healthy man today, but only through much vigilance and care. Beware of the consent form as I made suing impossible here. We did file a formal complaint with the board.

    June 22, 2011 at 18:16 | Report abuse | Reply
    • ICare

      Just how did the consent form make suing impossible?

      July 17, 2011 at 16:35 | Report abuse |
  38. CC NYC

    Our healthcare is as perfect as it is. I agree with Don_J. Don't let these right-wing nutjobs interfere with our beloved healthcare system.

    June 22, 2011 at 18:17 | Report abuse | Reply
  39. rav

    wao..and soon i will be starting my clinicals

    June 22, 2011 at 18:19 | Report abuse | Reply
  40. rav

    i am med student, and when i read do not go to hospital on July i thought my Pathology professor wrote this coloumn, because he always joke around in class saying he would never go to emrgency department in the month of July August and September because that is when new intern start working ahahahha.

    June 22, 2011 at 18:21 | Report abuse | Reply
  41. rav

    oh by the way it is true that in hospitals mortality rate is high in july aug sep, it is in one of the journals i can't remember

    June 22, 2011 at 18:22 | Report abuse | Reply
  42. Chet

    May I weigh in here as I teach interns and residents for a living – there is other work in the literature which shows no July effect, and in any case patient outcomes depend on quite a number of factors aand thus isolating one – the 'July' effect is difficult indeed. It could be that patients are sicker in July, or have a different rate of disease or (my theory) that the hospital is simply more understaffed and thus outcomes worsen. It takes sophisticated statistics to ferret out single factors like expereince of the house officers and even those are mere probabilities.
    My heuristic feeling is that the danger time comes around September/October as we start becoming less uptight about our new physicians, although they are still pretty darned new. Also we try to put systems in place that minimize patient danger and yet still afford opportunites for learning. all this is staff work which is rewarding, although tedious at times. Finally I would say that we now have a tool called simulation training which often lets junior doctors practise a scenario first so that they can automatically place the paddles on the correct side of the patient instead of the incorrect side, which is a very foreseeable error when you are really in stressed panic mode because this is your first code on your first night on the job. And of course you realize, this is why our difibrillators are now more or less automatic

    June 22, 2011 at 18:26 | Report abuse | Reply
    • rav

      just curious which state and hospital is that simulated code is used?

      June 22, 2011 at 18:29 | Report abuse |
    • emdoc

      Rav – lots of them. our hospital in NY has a sim center that med students and residents use routinely.

      June 23, 2011 at 03:09 | Report abuse |
  43. linda RN

    HEY DOC! can I come work where you are at? Thanks for recognizing that nurses DO KNOW SOMETHIN' !!!!

    June 22, 2011 at 18:27 | Report abuse | Reply
  44. Kate

    There is also a new crop of RNs coming out of school and into the hospital. Meanwhile, the seasoned RNs are taking vacation!

    June 22, 2011 at 18:28 | Report abuse | Reply
  45. Miller

    If you go through 4 years of medical school and still don't know where to place the pads for defib, you should be encouraged to become a plastic surgeon

    June 22, 2011 at 18:30 | Report abuse | Reply
  46. km

    As with any job, there are competent and incompetent people in all aspects of medicine from the people emptying the garbage to the nurses to the physician. I think a huge problem in hospitals is lack of overall respect. Lack of respect from the nursing staff to the physician (resident) and vice versa. Just reading the comments of this thread shows the tension between nurses thinking they are better than doctors, and doctors thinking they are better than nurses. Isn't our goal to use both our different skill sets to take care of the patient in the best way possible? There is a steep learning curve for anyone starting a new career. Brand new nurses can be just as scary as new interns. I think patient care would benefit from nurses and doctors showing a bit more respect for each others profession. If I would have followed every recommendation from "seasoned" nurses, I'd probably gotten fired. They have also saved me many times. As a patient, if you don't want residents involved in your care, don't go to a teaching hospital. If your a nurse and don't like/respect residents then don't work at a teaching hospital. There are as many good teaching hospitals and good private hospitals as there are crappy ones.

    June 22, 2011 at 18:31 | Report abuse | Reply
    • jonno

      That was like POETRY!!!!!!!!! Well put.

      June 22, 2011 at 19:13 | Report abuse |
  47. Jeebus

    You can have synchronised and unsynchronised cardioversion. Unsynchronised cardioversion is also known as defibrillation.

    June 22, 2011 at 18:33 | Report abuse | Reply
  48. pgauthi

    So everyone realizes you DON'T have to go to a teaching hospital, right? They don't necessarily provide the best care any month. Although I admire people willing to let themselves be "learned on" I don't quite understand what drives people to do this when they could go to a private hospital.

    At my training program it was mostly the uninsured that we learned on.

    June 22, 2011 at 18:34 | Report abuse | Reply
  49. js

    What he wrote is like the "House, M.D." version of how things work. Some truth but some exaggeration for dramatic effect.

    June 22, 2011 at 18:36 | Report abuse | Reply
  50. Jo Jo

    I had surgery in July for fibroid removal. My surgery went fine but was mistakenly given a blood transfusion. My doctor told me this on the third day after surgery (after being given two pints of blood). He said he did not know how this had happened because he had given instructions not to give me blood even though my blood count was low. So, I don't know if this is true for every hospital in July but I can only speak from experience. I wish I had known July was the month for new interns because I would have definitely postponed my surgery for the following year.

    June 22, 2011 at 18:38 | Report abuse | Reply
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