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.
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.
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A hospital is kind of like a pride of lions. The nurses do most of the heavy work, and the doctors come in when there's something big and scary to take care of... and to take the credit 😉
Just like the Aides compared to the nurses..... 😉
Another useless article . Another myth to unnecessarily scare the public. All points made can be easily countered. This is also written by one surgical intern whose training , focus etc are variable compared to other interns. Types of hospitals, medical schools and skills are not equal across the board.. Your care can actually be better because senior residents and nursing staff are often double teaming. Only truth to this article is that the one should always work as a team , question but respect the experience of nurses PA 's, techs etc. Shame on author. I thought we have put this MYTH years ago using evidence based medicine.
Implementing the medical decisions is the easy part...
Yes, the nurses do all the bullwork and "the doctors come in when there's something big and scary to take care of... and to take the credit." The doctors also assume the liability (bigger/more insurance). More like "Fried Green Tomatoes" and the parking lot scene!
In reply to author's post, I am so sorry that you trained in a place where your colleagues killed people left and right during july month!!!,
Your MCAT scores must have sucked!!!!, oh my god!!!.
Thanks to that nurse who saved your ASS, go ahead and put on a skirt and a hat and start wiping baby booties.
Man, I do not understand why CNN publishes this kind of crap!!, nothing near to real journalism, I am sorry to say this is nothing but scare mongering.
In a properly organized residency program interns are never left alone atleast during first few months, THEY ALWAYS HAVE BACK AND THEIR WORK IS CHECKED BY ATLEAST ONE UPPER LEVEL RESIDENT. And this check and recheck is best done in USA, believe me I have worked in UK, Germany and also some third world countries, the system USA has is the best.
Oh again please make sure that you do not go to the hospital that trained this doctor, you will find same kind of stupid interns like him working there, unsupervised!!! and dumb. Sorry Bro this aint right.
Are you surprised? I used to work in surgery. Doctors would call you in in the middle of the night so you could get everything ready, have the patient on the table and all the supplies at the ready and then come in from their power nap in the lounge and grumble how they were missing sleep. Nurses often fed them juice (or coffee if they needed sobering up) and surgical techs guided their hands if necessary, often performing duties that residents do in teaching hospitals while the docs sat it out on a stool. Then they'd sweep out and leave us to close, clean up and deal with the surgical aftermath. Many of them were out the front door before the patient got to the recovery room. You think they take the heat if something went wrong? Think again. I've seen entire OR crews get thrown under the bus.
Glad I didn't read this six years ago when I had heart surgery. Obviously I survived.
i like how the author explain "the july effect" and then quickly point out that he was immune to the july effect as an intern.
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What??? The nurse saved your ass??? SHOCKING!!!
As a new intern myself, I am in fact terrified to start. But the comments that state we aren't alone are correct. I could not be more thankful for my seniors and attendings. As for the hating on teaching hospitals, it is where you will find the BEST care in the country, hands down. They get the research money and therefore the "best" attendings. And for those making comments about doctors making mistakes, remember that we are people and not superhuman, regardless of how long we have been in practice. And I can only hope that when mistakes are made, the doctors would admit it. Honesty is always the best policy, especially when someone is trusting you with your life! I would just make sure you meet ALL the doctors on your team if you are admitted in July because there will be a range from intern-attending. Then, if you have any concerns, ask to talk to a more senior member of the team!
I hope people read this new intern's comments. They are quite accurate. I am an "allied health care professional"– not a doctor or nurse, but I'm around them all the time. I thank my stars that I'm NOT a doctor and don't have to shoulder these types of responsibilities. Yes, nurses and other residents may save an intern from making a terrible mistake, but chances are he will go to make another terrible mistake. However, he then learns from that and moves on. People have no idea how difficult it is for doctors, esp. now when 1/2 their time is spent dealing with insurance company bozos.
In a way it's really good that you're nervous, because you'll be that much less likely to get in over your head or make a judgment call that you're not experienced enough to make. You almost literally hold the lives of your patients in your hands. Most medical mistakes are minor and can be corrected, but there are some mistakes that are just inexcusable.
However, in defense of medical professionals, I strongly believe that hospitals and larger offices need to do as much as they can to ensure the health and well-being of those who work there. Patients deserve to be treated by a doctor, PA, resident, or nurse who is well-rested, not starving from going too long without eating, and is as calm, unstressed, and mentally clear as possible. I want my doctor or nurse to feeling good and clear-headed so that he or she can focus on treating me without distractions. If that means I have to wait 30 minutes longer for a pain med while my doc or nurse takes time to sit somewhere quietly and decompress while eating a snack, chances are that I can deal with it. I know enough people in medical fields than I can see how important it is for a physician or nurse or tech to be able to see to their own health as well as those they care for!
I wish I'd seen your post before July 1, but I'll respond now and hope you'll still see it. The day you start your internship was/is 20 years to the day after I started mine. I'm an anesthesiologist now and there's a lot more that I would like to tell you than will fit here. Most importantly though, is that the anxiety you have serves a positive purpose. Don't let it paralyze you, but allow it to keep you focused and careful. It will inspire you to check and recheck things, and to ask early for backup when you find yourself doing something that makes you nervous. Looking back 20 years from now on the practice events of you and your peers that you'd most like to re-do, you'll likely find many of them were preceded by a level of confidence that allowed these things to sneak up and surprise you. The other thing that will serve you and your patients well for the rest of your internship and residency is to think out loud among your upper level residents and faculty. They have no way of knowing what you know and don't know by looking at you, so tell them. If they tell you to put a central line or a chest tube in your patient and you've never done one, say so. Don't object or refuse. Just say something like, "This will be my first _____(insert procedure) or second____ to ever perform...do you want to watch to make sure I do it the way you do it...?". No one in a teaching position will respond negatively to that statement, especially in July. If you then announce where you think the central vein is before you sink the 18 ga needle into the patient's neck, you will have given them a chance to redirect if they don't agree. The worst mistake you can make right now (and you'll probably see at least one of your peers do this at least once) is to behave as though you are confident in order to make a 'good impression'. You will either scare your upper levels, or inspire them to trust you to do things alone that you are not going to be comfortable doing alone. Neither of these plays out well, and you miss out on the chances to get the input of experts in real time while doing something for the first time. Allow them to let you learn from the mistakes they've made years before. They will teach you habits that allow you to avoid their worst events. It's easier than learning from your own. If while intubating for the first time you relay to the person standing next to you training you to do it (an anesthesiologist if you can arrange it), it's ok to announce in real time what you see as you proceed: "I see tonsils...I see uvula...I see epiglottis...I see cords...". This saves the person trying to train you the scenario of trying to guess about what it is you see and how to redirect you. Thinking out loud for the people trying to train you will allow them to see what you already know, (and they won't waste time explaining those things) and also to see what you don't know so they can focus on filling those gaps. This is the best way to use the experience of your upper levels to make your learning curve as steep as possible. Last, if you find yourself confronted with an unanticipated code situation (or any other one where you know you're in over your head) like the one described in this article, page your upper level immediately. "How long did you wait to page us?" will be one of the questions that comes almost immediately after, "What happened with this patient and what have you done so far?"
You didn't save a patient's life. The nurse saved the patient's life. Thanks for pointing out the scary statistics though. I'll avoid teaching hospitals during the summer.
Yes, she did, by first grabbing a resident to run a code!
Question though...did this intern train 20 years ago? When I trained medical school provided years of clinical education (2 was the standard, though now its often integrated over all 4 years). Everyone in my class had advanced cardiac life support twice already before graduating medical school, and some were instructors. I smell a fish...
For those posters cringing at the thought of an inexperienced, trembling newbie physician getting pulled in to run a code for a cardiac arrest, here's a better perspective: Ventricular fibrillation is death. The worst he could have done to that dead patient is fail to bring them back to life. Quite possibly, that's the outcome that would have emerged had the patient not been fortunate enough to have this new intern be walking past his/her room when they decided to die.
It's every physician's worst fear that a mistake they make will cost someone their life. And, for the record, the same applies to nurses; their role allows for tons of dangerous mistakes (med dispensing errors, in particular) and they are more understaffed than physicians.
Imagine if you were an accountant, and every time you made a mistake on a tax return someone could die because of it. The only nutcases who would willingly make that personal sacrifice 60-80 hours a week are the men and women that care enough about helping strangers to be health care professionals.
Amen to that.
I am learning english and I like to read articles from the newspaper, to improve my english. I was delighted while I was reading this article.
Good for you!
Who do you think takes care of patience, not doctors, over paid dummies
It's patients, not patience. Who's the dummy now?
Most physicians will be in debt until they're at least forty years old from education debt alone; that's not even taking into account a mortgage or car payment.
I'm pretty sure you won't be saying that when you or a loved one is in the hospital one day (inevitably) and one of those "dummies" is making decisions that may determine whether you live or die. I believe respect is due towards those who sacrifice and spend the majority of their lives finding ways to extend and better the lives of others.
"that's not even taking into account a mortgage or car payment."
Then how's about you drop the 2.5-million mortgage, and the $225,000 car payment?
I wish! Only the lawyers can afford that!!!
I have $160,000 in student loan debt, a mortgage for $75,000 (house is worth $120K) and no car debt (our cars are 10 and 7 years old). I am more typical than what you think. Most of your doctors are just scraping by, just like you! And we work 60+ hours/week with the same crappy benefits you may or may not get (I pay for a big chunk of mine). I'm paid well, but not exorbitantly~ We do this because we want to help, we want to share. We sacrafice more than we ever get back! I have missed almost all my kids important school events, never got to go on a field trip, and disappoint my family way more than my patients. But I LOVE MY JOB!! I love the smiles when I can help, the thankful parents when I relieve some of their biggest dreads/scares, and even the ability to hug when I have to tell them bad news. I'm glad it is me giving them the news than some uncaring ass. Anyway, yes, July is scary, but some of the best care is in teaching hospitals. The nurses willl always stick up for the patient and the majority of the doctors in training will figure it out before a life threatening mistake is made.
"Then how's about you drop the 2.5-million mortgage, and the $225,000 car payment?"
I'm a family physician, and work about 60-80 hours a week. I drive a 2003 Honda Civic and live in a one bedroom apartment. I'll never go hungry or have to sleep in the rain, so I'm happy.
The doctors that you may be mistakingly referring to spent 17 years training. Because they were in school, they didn't make a dime until they were 25 years old, at the earliest. Instead, they spent close to a quarter of million dollars over that time on educational loans. They then earned ~$40k/year for their 9 years of residency (which is the average national salary). They work 80-100 hours a week until they retire. That's an average hourly wage of ~$100/hr over their lifetme, as opposed to the ~$25/hr for an average American.
Would you volunteer for 17 years of training, and more than doubling your time at work, to increase your wages by 4-times? (Oh, and by the way, if you screw up you may end up killing someone and/or get sued).
Thank you and other pediatric neurologists for what you do! When our now 2.5 year old was 5 months old, she suddenly began having seizures. Only someone who has had a kid have a seizure out of the blue knows how frightening that is. She was taken to the emergency room at the hospital where she was born, then transferred to a pediatric ICU in San Francisco later that night for observation and testing. After her discharge a few days later, our pediatrician (who is also a prof. of pediatrics at UCSF and just the best physician I've ever run across) gave us the names of a couple of pediatric neurologists and said we can't go wrong with either of them. She went on Trileptal for a year, then her neurologist had us wean her off of it and she has been seizure-free for over a year now.
The final score in this game: idiopathic partial complex seizure epilepsy, 0; pediatric neurologists, 1. You all rock!
Who do you think takes care of patience, not doctors, over paid dummies"
And hopefully NOT people who don't know how to spell PATIENTS! lol
As a doc, I can say without hesitation that docs are some of the smartest AND most highly motivated individuals- think about it, they're bright and driven and they are willing to defer making a living wage until their thirties! The debt is asinine. And who else works 80plus hours weekly EVERY week. Oh, and then free time is often spent reading about work-related matters!
Those knocking docs suck wish they had the brains OR drive, much less both.
Doctors are not the only ones who work long hours. My husband is an aerospace engineer and he works 70hrs a wk with 24/7 call, and does NOT make an MD's salary. The 40-hour work week is a thing of the past for most salaried individuals in the private sector today.
Don't go in the hospital as a patient on Christmas eve which was on a Friday.Every one that knew how to take care of a patient was gone for the week end and at mid night on Christmas eve two "techs" as they were called came into my room with whiskey on their breath wearing santa hats to change my IV.Hospitals are not the safest place to be anymore.They are just there to pick up a pay check and go home.
sure hope i dont start my rotations with the ICCU!!! eeek!
That sounds like basic knowledge – if you did not learn that in your4 years of Med. School – I worry for all of us.
Uh no. It's not "basic" foolish one. First off, one must gain competency in anatomy. Then physiology. Then pathophysiology. Then they have to learn stereotyped but complicated algorithms involving vasopressors, anti-arrhythmics, and cardioverson. Then, oh yeah, they have to verify that the assessment by the ancillary staff is accurate. Then they have to keep a cool head in a pressure-packed situation wherein the family/loved ones are often shrieking/crying nearby. Then they have to act. "Basic" science my ass. Fool.
Well thank god they are teaching all of that in Nursing School considering it was the nurse who knew what to do.
Dear Doc – the guy did not know where to place the paddles – you cannot tell me that was not covered in 4 years of medical school.
Respiratory Therapist here. I assisted dozens of patient intubations and thought I knew what to do... until I was at the head of the bed with a laryngoscope in hand. It was at that moment that I realized I knew nothing.
Summer, you can read and watch all you want, but you don't really learn until your hands are in the mix.
Everyone must remember that all physicians are human and they are all trying to do their best. They do what they can and not everyone will have a positive outcome. This is just the way the world turns. The vast mojority of physicians care so much for all their patients and only want the best for them. We must all start to learn somewhere.
It's amazing how ignorant most of you people are. Here's an idea – don't talk about things you don't understand, and don't criticize those who have sacrificed so much to try and make your life better.
You will make a great doctor; you already think you are smarter than everyone else!
i cannot stand nurses constantly trying to portray this image that they "save" the doctor's behind. nurses basically do nothing more than serve as robots that carry out doctors' orders and relay info to them. sometimes for fun i'll ask a nurse if she knows why we're doing what we are doing for a patient – the answers are usually comical. with some exceptions, they have no actual knowledge of medicine, but instead take pride in knowing what we usually do when x, y, or z happens without knowing why...then will regurgitate that as a sign of knowledge to a medical student or an new intern. within a month, interns have become used to the way the new hospital works and the nurse goes back to her place of acting superior to her friends behind the scenes and knowing in the hospital that she is SOL without the knowledge of that former baby intern.
I agree that there are nurses that believe they rule the world out there, but there are athletes, businessmen, professors, and such who act the same way. Also, I'd encourage you to really research to see what a nurse's responsibilities entail, because you have been misinformed (or you're living in the 1920s still). RNs are not robots who answer orders without question, but an additional team member in the healthcare setting who works alongside the entire team for the benefit of the patient.
I think your comment is harsh, but I agree that as with everything some people fit that bill, but it is not all. My favorite nurses are the ones who know their job and don't try to be a genius. They are humble and proficient. That is what I strive for also. I think the "super nurses" will get to take their medicine one day and get the rough edges taken off. I am grateful for a doctor who knows his job, but many don't and are dangerous for their patients because they don't have humility. It can apply to anyone.
You are absolutely right, nurses are idiots doctors are god!
You're the minority, and I know plenty of physicians who would tell you so. Research has shown over and over again, that the more interdisciplinary the team, the better the patient outcome. I see nurses help out attending physicians all the time, and I see residents educate nurses daily. It's a team effort. There is no room in medicine for the hierarchy you insinuate exists. I won't say that the nurses which you speak of don't exist, there are definitely some that I wish weren't representative of my profession, but you're the lot that medicine wishes didn't exist. You're an embarrassment to your colleagues. Medical education has begun a change. The interdisciplinary education and team-building between physicians and nurses begins before either are licensed. I'm looking forward to the new interns coming in. I can't wait work with them, help them if/when they need it, and see how our patients benefit as a result. At the end of the day it isn't about your or me, it's about the ones we serve. Yes, that's right, SERVE. Think about it this way, if researchers cured every illness and found ways to prevent every injury, we'd both be out of a job.
drew: sounds like the nurses have put you in your place, on more than one occasion....your "ego" and synicism speak volumes....and guess what; experience speaks volumes. something i believe you ....are defunct in?
Actually, nurses are part of an interdisciplinary team trained and educated to continually assess changes in patients' health status and response to treatment. A nurse's eyes and observant skill are what help you take care of your patients, many of whom you don't even physically see for more than a couple times a day. We are educated in basic pharmacology, disease process, anatomy and physiology and depending on our educational level and experience may be well versed in the standard of treatment for many diseases, allowing us to anticipate and prepare the patient for tests, procedures or what to expect in their course of care. We educate patients on disease prevention, healthy lifestyles and the side effects of disease and medication. We encourage patients to meet their maximum personal capacity for health, self-care and well being. Doctors are an amazing resource for their knowledge in treating disease. Nurses are amazing because we're at the bedside, on the front lines, helping people navigate through health and illness. We are not robots. You do not have a clue. We need to all start respecting each other.
This article is so true, and the last sentence sums it up beautifully! As a registered nurse I had a brand-new intern once ask me to write his admission orders for his patient, because he didn't know what to order. I told him to go home and come back when he was ready to be a doctor!
If you really told the intern that, you should have been fired. Believe it or not, how to write orders isn't covered in medical school. Try not being a 4 letter word and actually offer some helpful advice next time.
Unfortunately Carrie......... you will never be a doctor.
Captain hindsight: you must not have gone to med school in the US then. If you did not learn how to write admit orders in your third and fourth years then you clearly did not use your time wisely.
My guess was he was an international medical grad, or used a computer system that was different than what he was being asked to use and wanted to know how it was done at that hospital. I'm guessing the poster didn't keep her job too long.
I hate to break it to you, but orders are the first thing you learn how to do as a 3rd year medical student. It's the intern who teaches the medical student that skill. ADCAVANDIMLS should be tattooed to your brain by your first day as an intern. If your intern or senior resident isn't teaching you that as a medical student then they have failed you miserably.
Good for you, Carrie. Who wants a doctor who passes on his responsibilities? I worked twelve years in the medical field , saw my share of excellent nurses and excellent doctors, also saw the doctors who were only in it for the money (you can't say that about nurses) and nurses who were only in it because they wanted access to drugs and other stuff. The good ones value each other as professionals, with no hierarchy involved.
Want to not die in a hospital? Don't go to a "teaching" hospital. Period. If I go to the hospital, I want to be the patient, not some young kid's lab homework. Let Junior practice his scalpel handling technique on somebody else.
I'll say again, because you probably didn't read my earlier post. Good studies have proven that the care at a teaching hospital is better than the care at a non-teaching hospital. It more than makes up for the "mistakes." Perhaps it is because of the cutting edge medicine, perhaps it is only because there are so many MORE people involved in the care of the patient, I don't know. I know that teaching hospitals are where the most complex and sick patients are cared for.
I just looked up and read the study that the author is discussing (has anyone else posting actually READ the primary source?). This article he mentions is not a good study and filled with bias.
Teaching hospitals have the most cutting edge medicine, some of the smartest MDs and very good nursing.
Everyone wants experienced doctors but no one is willing to be part of the learning process. Please explain to me how you get fully trained physicians, nurses, techs, etc without letting them be involved in patient care after they graduate from training programs. Physicians at non-training hospitals were previously trained at teaching hospitals. Its a cycle and there is no other way to get around it. The point you are failing to understand is that in my experience the junior providers are highly supervised. No intern gets a scapel and is allowed to do surgery. First they have to watch the ward patients and change all the dressings and run the clinic before they ever step foot in an OR. Even when they do get to an OR they can't even breath unless the attending allows it. Residents don't perform any independent surgeries until they are in their last year of training. This is how all the specialties are. So yes there are new interns in July but they virtually have no responsibility. And yes, it's everyone's responsibility to make sure they don't screw up including all members of the team, docs and nurses alike.
I had my baby in Santa Barbara in July. There was a resident there but it was fine.
Is this a news network? What is the point of this story? To scare people who need to go to the hospital into NOT going to the hospital? The headline alone is bad enough considering most people don't even read the articles. If you're rushed to the ER in July, I'm guessing you didn't plan on going, and you won't be thinking of how inexperienced the doctors are. What about the examples of young doctors saving peoples lives in July? Does it never happen? Everyone dies? What an awful fear-inducing story. Back to BBC where they report real news instead of trying to scare people. Cripes.
It's a blog. Blogs are for commentary, opinion and even humor. It doesn't have the same standard for objectivity that an actual newspaper or traditional news program would.
Right on, RN. I thought the story was touching and amusing. Yes, the patient was basically dead, so asking an intern to run the code WHILE the more experienced residents were being called to the room (they did show up, remember?) was a perfectly appropriate thing for the nurse to do...and helping him place the paddles in his terrified state was as well. This patient was lucky they were both there.
Ignore all the haters. This was a good article. I enjoyed reading it. You did save a life that night. I'm very glad you take your job seriously and bet you are very good at what you do.
Dear. God. Above. If I'm about to die, bring in a nurse! I'll pay out of pocket on the way out. I do not want a person reading over a book if my heart is moments from stopping. Even if this story is sensationalized, it scared the s*** right out of me!
Thank you for sharing that physycians are human. I think that many people forget that, sometimes even the physician himself.
Excuse me doctor......I think you mean defibrillation, not cardioversion. What a useless article, if you were current on your literature you would know that is myth. Journal of the American College of Surgeons (which I assumed you would be familiar with) published a study in 9/2009 of 26,000 trauma patients demonstrated no difference in mortality. Journal of Trauma published a 5 year study with 24,000 patients out of LA County Hosp. which did demonstrate a higher complication rate but no difference in mortality. This has also been replicated in cardiac patients undergoing CABG as well as OB patients during delivery. This article does nothing but harm medical training. You should be ashamed and embarrassed for having written it. Stick to plastic surgery.
I see you've been reading your pocket versions LoL Defib is the action of stopping, cardioversion is the medical procedure itself. They are virtually the same thing, with the exception depending on where they appear in a sentence – it's grammar.
Definition of Cardioversion:
Cardioversion is a medical procedure by which an abnormally fast heart rate or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs.
Definition of defibrilation:
The stopping of fibrillation of the heart by administering a controlled electric shock in order to allow restoration of the normal rhythm.
Spot on. And yes, Jason is right; the terminology used here was incorrect. Cardioversion attempts to shock a heart in an abnormal rhythm back to something more normal. Ventricular fibrillation isn't really even a rhythm and therefore uses defibrillation. The two are pretty different; one uses synchronization with an existing rhythm (cardioversion) and a lower power setting compared to the other (defibrillation). I also agree that this was very damaging to medical education; as an intern starting in a few days, I certainly hope I don't have patients refusing my care simply because they read this article and assume that none of my classmates or myself know what we're doing.
Hi Dave C, good luck to you and all the interns starting soon. I find a lot of this discussion highlights the tension that can exist particularly in teaching hospitals between doctors and nurses. Be aware and prepared for the fact that you will encounter nurses and other doctors who will have no patience for any mistake you might potentially make. There are those in scrubs and jackets whose egos make no room for a spirit of collaboration in the patient's best interest. All they want is to feel superior. But for the most part, as nurses we just want to take the best care of our patients and see that everything possible is being done for them by the medical staff. We want to be heard and we want to be in on the loop. Please, collaborate with your nurses. Talk to us. Tell us the plan so we can be informed and make the appropriate assessments. And listen to us – yes, you have amazing knowledge that we are in awe of (and yes sometimes jealous of 😉 don't tell the other nurses I said that) but our experience is something that cannot be undervalued. I'm excited for you all. Best of luck.
if MD stands for "making decisions" then RN stands for "refusing nonsense". Really tho..I've been an ER nurse for 22 years..boneheads come in all sizes, shapes, and qualifications. The best care is given when everyone works as a team, respects each other's knowledge, and recognizes their limitiations just like any other job. Have I saved a few MD asses over the years? Sure! Have I seen some MD's make amazingly hard decisions? Sure! All part of the job. Just keep the job patient focused and leave the egos out of it.
You're anskig for quite a bit of info .I'm not sure that this is the proper forum. Are you anskig for other NICU people to tell you what equipment they like best?
Perhaps Dr. Youn should make better use of his time and (?) medical knowledge to write scientific papers and not bombastic articles that just entice the lay public... The best thing that can come out of this is to ask for better scrutiny of teaching hospitals during the month of july...
Oh...and one other thing Dr Youn. As your website states you trained in General and Plastic surgery at the Grand Rapids plastics program. After completing an integrated plastic surgery residency I wouldn't go around claiming I trained in General Surgery as we all know that is hardly the case.
Fine story, point taken. But you left out the part where you humbly and sincerely thanked the Nurse who saved both you and the patient.
As a Critical Care RN, I have seen the "deer in the headlights" look on many new residents. It is a position that each and every single health care professional has been in, especially at the start of their careers. We all need to realize that no one walks out of college with ALL they will ever need to flourish in their field. It is through experience that we all learn, no matter WHAT the profession. In my years as a nurse I have seen nurses come through to save a doctor from a major medical mistake. I have learned to respect the MD's knowledge and appreciate their expertise in treatment of the disease process. I frequently say "Doctors treat the disease, Nurses treat the patient". It is a collaborative effort that together helps our patients heal in a safe environment. At the University I work for, our MD's listen to our input and react appropriately to our input and requests. To the MD's that left the ignorant comments about the role of a nurse, I hope you take time to re-educate yourself. Some day, soon I have no doubt, a nurse where you work will do something amazing to help you. I just hope you have the insight to see it for what it is worth, and appreciate it. You need to spend just one FULL day with an RN. You have no idea what we do. You look down your nose at us like we are less than you. But guess what, your body functions in the exact manner that everyone else does. Please enlighten me on what it is that makes you superior? I respect your knowledge and education, but YOU need to respect others as your FELLOW HUMAN BEINGS.
thanks MInurse, i appreciate your honesty and understanding that docs and nurses have different skill sets. A doctor is obviously trained more extensively in diagnosis and treatment modalities as that is basically what med school teaches us, while a nurse's training may focus more on patient care. Med school teaches docs how to gather info, synthesize it, come up with a differential diagnosis, and then a plan. Med school does not focus heavily on patient care or hospital logistics or how to run a code though these skills may be picked up by many young docs along the way. So in terms of patient care or running a code, a nurse working on the floors or in the unit will obviously know more than the brand new intern. But what people here fail to realize is while that intern may be weak on practical skills, he/she still has a large fund of medical knowledge that may not be immediately useful while running a code (which is basically all protocol anyways) but should still be respected 🙂
what have u been smoking anthony
This is real life people. Forget about all the "super" doctors on TV, they don't exist. If your Doctor claims to know everything, they are a lawsuit waiting to happen. Medicine is a lifelong learning experience with knowledge constantly being updated or added.
Question though...did this intern train 20 years ago? When I trained medical school provided years of clinical education (2 was the standard, though now its often integrated over all 4 years). Everyone in my class had advanced cardiac life support twice already before graduating medical school, and some were instructors. Most also had hundreds of hours of healthcare experience before even starting medical school. I smell a fish...
I don't understand. The neo-Cons tell us that America is the greatest country in the world, that Americans are better than everyone else and that our health care system is the best in the world.
This system is failing, and the person who wrote this article has quite a bit of courage to admit it. Good for him. And, what another embarrassing fact about the "greatest nation" and it's health care system.
The BEST country in the world!!! Wave your flag!!!
Your name-tag is quite deceiving. Every developed country has a similar system of medical education to the United States. You really have no idea what you're talking about.
You're right it did take a lot of courage to write it, because it is factually incorrect.
Dear Dr. Youn, thanks for sharing your thought and article. I have one question, everyone knows medical school does not teach you to be independent physician on the first day of internship, so WHY we have American citizens who have earned the Medical Degree, but they have not awarded medical residency? Technically, they will all perform the same or almost the same. They have no criminal background. I look forward to hear comments of Dr. Youn to this matter. Thanks in advance.
This is irresponsible journalism. To imply that you should not go to a hospital is dangerous. Patients have enough on their mind, and don't need to be worrying about errant interns. Maybe if you need plastic surgery (this particular authors specialty) you could wait it out to August. Otherwise, I suggest coming to the hospital.
Never go to the hospital in July? Never? Really? You are going to put that as a headline to an article on CNN telling all of the mindless, impressionable sheep that it is dangerous to EVER go to the hospital in July?
I will bet you that more people are harmed after reading this article and deciding to hold off on visiting the hospital than those harmed due to intern error. Yes, people are that stupid.
Seriously, everyone on this needs to chill. It says he wrote a humorous memoir, this is just a cute, entertaining article, nothing to get all upset and take in all seriousness. Yes, doctors have a sense of humor too!
i know i'll catch alot of "flack" about this question, but how does the public feel about "interns" practicing on those persons
who need help, but have no insurance? would that maybe benefit "both"? please comment...would love to hear responses....
It's true that the nurses appear to have a better sense of what's necessary for medical care than do physicians. It's also true that, as in any craft, new doctors must go through a learning process once they are out of the classroom and in the real world.
well this story is obviously hyped up to get some more views. Residents are never left on their own and not everyone has never touched a patient, dental residents or OMFS or surgery have done plenty of procedures that can qualify them to tackle most of the everyday situations. Even experienced professionals fail at their jobs so why have the public in panic just to get more site views, sorry cnn that was sadly pathetic.
also if society wants better residents why not hire a few more physicians to shadow them and pay them better salaries that way they stick around longer, or how about this idea have them work less hours.
I gave birth for the first time in Grant Hospital, in columbus ohio. Interns were doing the part of the clean up, after birth when the real doc left. the cord separated from the placenta that had grown into the uterine wall and I was bleeding internally, my cervix closing down. They had to summon the doc and he ran in, put his arm in the bucket of iodine and fisted me, arm inside,to reach in and peel the placenta away. It was worse than the all natural child birth and i never went back to Grant after, I had a parade of interns the whole pregnancy and felt like meat.
On the plus side, the hospital upgraded me to a terrific suite. Big and private. So i guess it paid being a lesson for interns.
I'm sorry that you had that unfortunate, though common, complication of childbirth. Please explain how the failure of your placenta to detach from the uterine wall was caused by the intern.
drfrompitt don't you know that interns are notorious for causing placenta accreta, they're also lesser known for rupturing appendices and lung cancer
Lucky you that the "parade of interns" were quick enough on their feet to get an attending to help you before the situation became serious. People who refuse to be seen by medical students and interns because they want "better" healthcare, actually suffer as a result of receiving less attention while hospitalized. If you want to be seen immediately, have your intern paged. They can call the attending in their office or in the OR if there's a problem they can't address themselves. If you demand to only be seen by an attending you'll wait all day until they're done in clinic or in the OR.
Fear mongering idiots.
This is not about freaking nurses... Low self esteem people always trying to sneak into MD's topic.
what does "MD's topic" cover, tom...
Let me guess you are a doctor with very low self-esteem.
repeat: practice and experience.....speak volumes.
Sounds like the Kitchen Confidential for med students.
Question for Tom; Was there doctors mentioned in this story?....Yes.....Was there nurses mentioned in this story....Yes.....Then this story involves both doctors and nurses. What makes you assume that nurses have low self-esteem? I think it's your own personal bias.
just remember most hospitals are NOT teaching hospitals. something very important not just in july, but any time you feel the need to request a transfer to the nearest "US news best such and such." you may get a great researcher, top of their field and so on, but the minute by minute decisions are made by the interns and residents, not that great specialist you so wanted to guide your care.
Next time you are a patient in the hospital, notice that the Doctor will see and talk to you for 15 minutes out of 24 hours. The nurses will be with you for the rest of 23 hours and 45 minutes of the day. While the knowledge of your Doctor is valuable,extraordinary and necessary for your healing and recovery, the nurses skills of observation of your symptoms, coordination of your care and problem solving are equally important. Don't undervalue the role of the nurse in your comments....we are your lifeline to excellent care. Many doctors don't realize this until they are patients themselves.
As a RN who worked in a teaching hospital for 5 years. I know this effect well. Often I was at the bedside with the Intern asking me "what do I do??" My response was "go ask your senior." As a nurse, I am always happy to point the intern in the right direction but what I have in mind and what the team has in mind might often be two different things. I agree with the new intern who posted here but I also have had some senior residents that should have never made it to that point in the first place. I've had a patient bleeding when I came on shift and I walked up to the senior and the new intern and asked "why are you ordering blood thinners on this patient? He's bleeding!" The response from the senior was "Oh, good catch!"
Rely on your MD's but always check with your nurses to make sure that whoever you have as a doc isn't accidentally trying to kill you. We are taught in school that we are your "last line of defense." It is up to us to check and double check, question and raise issues that the MD might not always see. And Ter-RN is right. We are your lifeline to excellent care and we are proud to be that.
I also worked in a teaching hospital and this is absolutely correct. The nurse is caring for 2-10 patients on average during her shift (depending on the setting), whereas the doctor is managing dozens at a time. The RN has a more intimate knowledge of the patient's minute-to-minute status, and it is his/her job to convey this to the MD.
All medical students should be required to take at least the basic EMT course in addition to their medical school classes. I've seen EMTs and paramedics who know more than most newly-minted MDs.
I was a paramedic before becoming a doctor. I've seen many medics who *think* they know more than MDs. it's fun to puff up your self esteem by trading embellished stories out in the ambulance bay, eh? besides, all doctors get ACLS and/or ATLS whereas EMT training just teaches you how to do CPR on a dummy
Most of the paramedics I know are nursing school/college drop outs who think it's fun to drive with sirens on and think they're cool because they get a police scanner to carry around. When they call into the multiple ERs I've worked in, half the time the attendings give them instructions simply to limit the amount of damage they're doing that will screw the ER team over when the patient arrives. Next time I get sick i'll drive myself to the hospital (oh, wait, I'm a resident, I live there anyway) rather than put myself in their hands.
As a hypochondriac I probably shouldn't have read this. It's also contributing to my growing fear of doctors. I used to love doctors and hospitals because they made me feel safe, now I feel like they're dangerous and full of uncaring people. I'm probably wrong, but I need to work on this fear before it ruins me.