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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 (2,421 Responses)« Previous 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 Next »Leave a Reply to TonyInNYC
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Medical doctors must be public officials.
No, thanks, I don't have any confidence in bureaucrats.
Four years of medical school but he can't remember high school biology and anatomy? He should have thanked the nurse publicly and to his supervisors. I hate dealing with most doctors. They are typically no smarter that the average auto mechanic and I may have to lean toward the "grease monkey" .
Anthony, thank you for such an honest article. As a nurse that has at times been the one to yell "stop!", I can tell you that each member of a medical team appreciates honesty and teamwork – it's what makes for great medical teams. Your honesty and integrity in admitting your own need for further learning, as well as your tackling that learning, will serve you well. We all learn from each other, and in the end, form a solid team.
@bellamy
I wager they have double the education you do
Once again, medical doctors must be public servants.
This applies, of course, to teaching hospitals only. The rest do not have residents and interns.
Thanks for adding that last line.
I hope you bought that nurse a bottle of wine for saving YOUR ass.
That's why interns have second years, third years and attendings. And if all those MD's aren't enough they have nurses of all rankings behind them asking what they'd like to do and using their experience and expertise to step up if the intern freezes. I'd like to see the initial studies and the variables/constants they used when inducting the research for these results.
Sincerely,
The little sister of an Internal Medicine intern.
I totally agree with you and thanks for the enlightenment . I think it's not the lacking of experience of the interns is the issue (what they claim), but the load of work and work time involve. The interns work twice as hard as the nurses and receive just a fraction of the RN's salary. Mostly work 12/7 every other week at least.
One thing the new residents haven't learned, is normally you will never see a nurse at the head of the bed, that would be a RESPIRATORY THERAPIST.
Sincerely your RRT
THANK YOU!!!!! Well said!!!
That is so true. On many occasions when I entered a coding patients room they still had a nasal cannula at 2 lpm. Then we arrive and maintain the airway.
I love our RRT!! They are the best.
HAIL THE RRT, RCP, LRRT, etc!
And then when a real airway expert is needs... Call anesthesia.
RNs and RTs...best of buds and keeping interns from killing people lol:-D
@name
advanced airways are overrated in codes. If anything, placing them detracts from the real help–chest compressions
This article hit a nerve. My Mom passed away in a hospital seven years ago...in July. She went to the ER complaining of stomach pains, was admitted, and two days later went to sleep and never woke up. I'll never be able to prove it, but I always thought that staff negligence and a bad mix of meds was to blame. But, when it's your time, it's your time, I guess.
Have good nurses.....all will be fine.
If new residents/interns are willing to admit they don't know everything and listen to the other, more experienced providers in the room (even if they're not physicians) mistakes can be avoided. Most of the nurses, paramedics, EMTs, and other care providers with whom these new residents and interns work do have experience and do know what to do. They may not be able to do it all for you but if you admit that you don't know something and ask for help no one should think any less of you, especially if you're new.
I hope you used some gel before you zapped him otherwise it probably smelled pretty funky and he had some nice burns.
Sort of disappointing the nurse in the story didn't run the code. Was this awhile ago?
This is a true picture of the hospital I am working as an accountant. But, I thought all this happens in less less developed countries like mine, Nigeria.
So I am facing two surgeries in July, what should I do?? WAIT, it looks like!!
But, do they know any more in August then they do in July??
One month's worth of knowledge 😉
You most certainly did not save that patients life. The nurse did. As a veteran OR nurse in a teaching hospital we love our residents but lets give credit where credit is due. I have helped more residents start a lines, intubate, start iv's, order meds and what not. The residents would be lost without their nurses behind them!
I love how you didn't acknowledge that a nurse saved your a** from a major screw up and you had the guts to state at the end to "then check with your nurse to make sure they know what they’re doing" What a pompous person you are.
-Sincerely, Veteran ICU Nurse
He was saying to check with the nurse to make sure the INTERN knows what they are doing. Guess they don't teach reading comprehension in nursing school.
Sorry boknon, that is not what that sentence reads as one bit. Do not knock reading comprehension when you read it wrong yourself.
"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."
It's a poorly written sentence, as the antecedent does not directly precede the pronoun, but the intention of the sentence is clear because the article is not about the experience of nurses but rather, it is about the experience of nurses and how this doctor was helped by a nurse during a code. Hence, "they're" is referring to interns and not nurses.
Change that to "the article is not about the experience of the nurses, but rather, it is about the experience of the INTERNS" Sorry
I thought it was pretty clear in the context of the article that he's saying the interns are new and might not know much so you should check with your nurse who does...
We're talking about life and death.
You don't simply "think" a person meant to do that, or this.
You never assume things.
You always ask for clarification.
You don't guess.
again, you never assume that he was talking about the interns.
what if he was talking about the nurse?
are you 100% sure?
danny – i also could clearly comprehend "they" as reference to the "new interns" in the preceding sentence
bokonon was quite correct in knocking on your reading comprehension
You guys don't know what you're talking about. He was talking TO the patient, telling the PATIENT to treat the INTERNS with respect and then check with the nurses to make sure they (the INTERNS) know what they are doing. It was clear as crystal when I read it.
I understood the context of the sentences.
Zwo talutshedzwa zwavhudi vhukuma, kha hu livhuwiwe Muongi uyo.
One of the greatest resources for an intern is your pharmacist (not as first line as nurses typically though). We love nothing more than to actually be utilized. USE US. 🙂
My mom died in a hospital in Phoenix, AZ. two years ago on July 13. I took her to the emergency room on Monday, and she died on Friday. Up to this day I still don't understand what happened and I feel so bad for taking her there 🙁
The nurse inferiority complex in dripping off my screen and onto my lap. No other field plays the victim and demands accolades more than nurses. Sorry, you guys aren't docs even though you seem to think you are.
We don't think we're doctors. We HELP doctors when they're brand new, clueless, and about to drown. This isn't about ego, it's about what's best and safest for the patient.
Vfib needs defibrillation not cardioversion.
I'm glad I'm not the only one to notice that he said cardio version instead of defibrillation...and I'm a labor and delivery nurse!
This "doctor" still has no idea what he is doing. He is trying to cardiovert ventricular fibrillation. Ventricular fibrillation should get defibrillation! Maybe this attending needs to take ACLS again before writing an article for CNN.
He got the wrong note I guess. He he. Kidding. But, yeah, as what I've mentioned above Vfib needs defib @ 360 joules for monophasic defibrillator or 200 joules for biphasic.
Defibrillation is also known as unsynchronized cardioversion...just saying
Not to offend any nurses, but these interns may not be proficient in the clinical setting on the first day of training, but they sure as hell are way more intelligent about the human body and physiology than these comments give credit.
Medical School is something that only those who endure it know what it's like. The amount of material covered is mind boggling.
This is why nurses should be paid more. Pretty sad when they know more than a four year medical grad.
Sigh... Doctors, they think they know everything, some even thing they're god. But we all need them. Nothing we can do but live with this complex. Sigh...
The comments to this article disturb me much more than the article itself. At the end of the day, health care is a team effort and nobody understands that better than us interns. We are definitely inexperienced and fumbling around, we find ourselves lost in hallways more often than not. But we do ask for help when in doubt and our sources of info include veteran nurses, residents, attendings, almost anyone who is willing to help! The lack of confidence we have is scary and the look of despair and disgust that the people in the above comments give us interns is definitely not helping with the "team work". At the end of the day nobody wants to hurt a patient and I feel a properly functioning team definitely makes sure that doesnt happen. It isnt about who knows more – it is about being willing to take advice from people youre working with.
So glad someone said it. Everyone is always looking to point the finger of blame and give themselves a pat on the back. What happened to teamwork? What happened to doing what is best for the patient. Everyone has to learn. EVERYONE. Sorry that some patients may be affected but, but many lives will be saved because of the healthcare team that all had to learn. Even those veteran doctors and nurses had to do what LEARN. Stop being so hard on the doctors, Ive had a few that may have needed some bedside manner training or compassion, but I dont think anybody intends to hurt a patient. I could be just niave.
Couldn't agree more. We are a team of medical professionals, and need to work together, using each other's greatest strengths, to serve our patients to the very best of our abilities. The amount of arrogance and negativity in many of these comments makes me glad the commenters are not on my team!
This scares me as cardioversion is contraindicated in V-FIB. Defibrillation is the correct treatment. There is a difference. due to the timing of the delivery of the electrical shock and possibly the amount. Medics, PAs , RNs and MDs all take the same Advanced Cardiac Life Support class, so we are all on the same page.
While I agree, it wouldn't make any difference in this case. The sync would just fail. No need to be scared. The real problem is an unsyncronized cardio version when it should be synced
Last year I had A heart attack I was 74 years of age and the female doctor was so rude and mean to me, she acted like I was making it up, when they did the test and found out that I was having a attack she came I my room and sort of apologized. This doctor could of killed me,she was making judgements before they did the test. I do pray she never treats other patients like she treated me.
This is a good time to visit the hospital if suicide is your last choice to score a free ticket to" the freedom beyond ".
Uh, I don't think I have ever heard an ICU nurse ask a doctor "what should I do, Dr." during a code. Most of us can run a code with our eyes closed.
You don't cardiovert a Ventricular Fibrillation, you defibrillate it. They are different..
It is still a cardioversion, it is just unsynchronized. Please see synchronized vs. unsynchronized cardioverion.
Holy crap....Thank Jesus Hallelujah for Nurses!!!
Check with your nurse, always assuming you'll be able to find one in July. Because, like everyone else, your nurse is probably on vacation. Already understaffed nursing units are stretched even thinner during the highest vacation month of the year. Another reason you might die: nursing shortage.
Incredibly irresponsible writing. The fact that soon-to-graduate residents may be careless in June – or the fact that interns have senior residents and other folks above them watching – seems to be forgotten. How about people investigate the actual types of medical errors – and by whom – before blaming interns.
If Only new residents showed veteran nurses the same respect as this tale... They might learn a lot more, and harm a lot less...
As I'm reading these comments all I notice is one thing. You nurses are some really bitter people. I can feel your hatred toward the doctors...if you wanted to talk like you are the doctor then maybe you should have gone to school long enough to be one...then you could finally get the credit that you bitter people crave.
This is such a big warning...As an MD working in the research field, I also wanted to see the journal article/study that the author mentioned in this article because it might give a wrong impression on the patients with regards to seeking consultation on the month of July especially if they are in real need of medical attention. in addition, this might spark an increase doubt among patients which might lead to medico-legal issues later on...To the author, maybe it might help if you cite the specific study that you mentioned int he first part of your article so that we can be more enlightened with your premise about not going to the hospital on July...Thanks.
The error in this is that you didn't feel it was acceptable in this scenario to admit aloud your inexperience and as the RNs to share theirs.
The fact that student doctors and qualified doctors are either too egotistical or too defensive to ask for advice from staff who have been on the job for decades is the greatest negligence of all.
They would rather kill than ask for help, pathetic.
The July effect would also be increased by less experienced casual staff covering seasoned RNs vacations, as well as the reduced number of qualified doctors putting a greater burden on student doctors.
Again, the greatest error is trying to do it all solo. No you don't have to take the RNs advice, but it's negligent not to ask for a second opinion when you have highly trained and experienced nurses, respiratory, cardiology staff... Yes, you've had a lot of education, far more than us, but there's no way a new resident has seen and interpreted somewhere near 200 thousand ECGs, as I have done over the last 34 years.
The smartest and most accurate residents are the ones who gather ALL the information they can in the time allowed, from all possible sources before making potentially life threatening medical decisions. That process should include consideration of input from support staff if truly informed decisions are the goal.
He could have at the very least gave thanks to the nurse who really DID know what she was doing!!!!!!!!!! ASS
If the medical industry would just RESPECT the importance of EXPERIENCED nurses the maturation process for interns and residents would be faster and more effective. Look at it this way; when a military officer gets his/her first combat assignment he or she relies upon the experienced non coms (sergeants and petty officers) to get him up to speed. Those men and women have been on the front line.
I'd like to ask all of the nurses (ICU, OB and otherwise) and other ancillary staff just how many codes they ran successfully on their first day on the job. It's relatively easy to become an expert in something that you do all day, every day for weeks, months and year, especially if your field is limited to one organ system. I don't care what your credentials are, nobody starts their career knowing everything and functioning at the top of their field, whatever that field is. Dr. Youn is simply recounting an experience he had, that many of us have also experienced and can relate to.
Young Dr. Youn's father was my physician. He was kind and honest and it appears that he raised his son to be the same. As an RN in the very same hospital that young Dr Youn's father practiced in, I understand the immense responsibility and honor it is to care for critically ill patients. How refreshing it is to hear a physician admit that they feel the full force of that pressure as well. Happy 4th of July wishes sent from your home town Anthony!!!
I agree with you, Dr Youn must be exceptional, how exciting to work with someone like him.
We all have our war stories if we work in the medical field. Thank goodness there are seasoned nurses and residents that help those July newbies. I did work in a teaching hospital and if you take the time to help them, listen to their thought processes in about 6 months they are not a newbie anymore. I love this author's honesty it is refreshing.
Its really a shame that physicians like this write articles to scare the medical public without knowing what they're talking about. For clarification about the REALITY of a teaching hospital, it would be extraordinarily unusual for an intern (first year resident) to be running a code by themselves. There are code blue "teams" available in the hospital 24/7 and they include senior residents/interns and sometimes attending (if they are in house after hours). Typically a code blue (such as the "ventricular fibrillation" case which was described) involves a crowd of physicians running in (nurses, general physicians, anesthesiologist, pharmacist, etc), often so many that unnecessary people need to be sent away to make space.
Secondly, if you finished medical school without knowing what to do in the case of ventricular fibrillation without opening a book (which is the most basic part of CPR/ACLS certification that needs to be completed while in MEDICAL SCHOOL), then you probably shouldn't have been allowed to finish medical school anyway. Either this case has been fabricated or the author really has an unusually poor basic medical knowledge (less than the typical 4th year medical student).
Thirdly, I'm really curious where he was planning on putting the paddles before shocking the patient in the first place. You are delivering 300J of energy through the body and unless you're putting the paddles on either side of his foot or head, you should be able to defibrillate a patient relatively easily. To give a sense, AED devices are designed for non-medical trained individuals to place on a collapsed persons chest in the public and it delivers the shock. No training involved. So essentially this author's judgement about placing paddles on the chest was worse than a bystander off the street.
Perhaps the only portion of this comment which resembles accuracy is that the nurses (particularly seasoned ICU/CCU/MICU nurses) are incredibly invaluable to every physician, no matter the training level. It is true that July has less seasoned individuals at all levels (residents, fellows, attendings). However, the level of supervision of trainees is also much closer and the attending physicians will double/triple check what the interns are doing much more (by the springtime, many senior residents/fellows function relatively independently).
Hopefully CNN will find more competent physicians to write stories/articles for them in the future.
My utmost respect to the new residents, in addition to our nurses, RTs, and all the crew, too many to mention here, but near and dear to my heart. I'm a former RT and now newbie RN. I feel nervous sometimes, as I'm sure the new residents feel. Yesterday a new resident asked me how my patient was, so I rattled off from GCS down to his foley. As I walked away, the new resident told my preceptor, yikes, it's my first day on the unit, so I don't know what to ask. My preceptor told him, she's my preceptee, and she's learning what to tell you. That made me giggle, we're in the same boat <3
Defibrillation is also known as unsynchronized cardioversion. He's not incorrect in using that term.
-ACLS instructor
This was a great read. It's very interesting, because even though nurses get laid decent money, they definitely do not make enough for all the things they truly do. Same can be said about NA's. It's interesting that going to school for 8 years earns you the right to earn $100,000 , even when doctors do half the hands on work nurses do. For all the nurses out there, continue to be GREAT!!
The comments above sound ignorant. The author was talking about new grad doctors and the inexperience they have; and all the nurses are screaming "murder him". Can we talk about all the new grad nurses for a month?
... for a moment(I meant to say).
Should have started cpr first and resumed compressions immediately after shocking. Ramin, how have you managed to visit every single teaching hospital in the united states in order to validate your comments? Or, are you just applying your experiences of the resources available in your own hospital rotations to every hospital in the u.s.? Trust me, there are some places where interns can find themselves in tough situations without immediate supervision. And finally, a strong fund of knowledge for a med school graduate, and the ability to apply that knowledge in the face of a dying patient, are not concordant.