With almost no experience, newly graduated medical students enter teaching hospitals around the country every July, beginning their careers as interns. At the same time, the last year’s interns and junior residents take a step up and assume new responsibilities.
In addition to developing their nascent clinical skills, each entering class of interns must grasp the many rules and standards for operating in this “new” hospital structure.
More experienced physicians share a joke about this changing of the guard: Don’t get sick in July…
“The good news for patients is that in most cases, it’s very difficult for a physician to make a mistake that results in a patient’s death,” said Anupam Jena, HMS assistant professor of health care policy and of medicine at Massachusetts General Hospital and lead author of the study. “But for severely ill patients, health can be very tenuous. A small error or a very slight delay in care is potentially devastating…”
Overall, they found that patients at teaching hospitals had a lower risk of dying than at non-teaching hospitals, but in July, the risk at teaching hospitals rose to the same level that patients at non-teaching hospitals faced. For high-risk patients who came to the teaching hospitals with heart attacks, the risk of death in hospital went from 20 percent to 25 percent. They also found that among teaching hospitals, the difference between outcomes in May and July is greatest in institutions with the highest percentages of trainees.
The researchers ruled out two potential factors that they suspected may have accounted for some of that difference — the prevalence of percutaneous coronary intervention (i.e. cardiac stents) and of complications from the use of blood thinners.
Without evidence for specific procedures or protocols that could prevent increased deaths, the researchers said that their findings suggest that, especially during the early months in the training cycle, oversight should be intensively focused on high-risk cases rather than across cases overall. In July, doctors with more experience should play a greater role in the care of high-risk patients than has typically been the case.
I never ran into this dicho before. Though it has been at least 40 years since I worked in a teaching hospital. And it was one of the very best.
Still – remind self not to have a stroke or heart attack in July. Especially since the only hospital in town is known as Saint Victims.