July: A Deadly Time For Hospitals

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A recent study found that more patients die of medical mistakes in the month of July than any other month. Inexperienced and overtired doctors may be part of the problem. David Phillips, professor of sociology at the University of California, San Diego, talks about study findings with Michele Norris.

MICHELE NORRIS, Host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

A new study has documented a bit of anecdotal medical wisdom. It's called the July effect. And it happens this month every summer, when thousands of new doctors arrive at hospitals to begin their residency programs and take care of patients for the first time.

The notion that some of these rookie doctors would bungle their responsibilities because of inexperience and sleep deprivation has long been a hospital ward myth. David Phillips wanted to find out if the July effect is more than just a myth. He's a professor of sociology at the University of California, San Diego. His study was published in the Journal of General Internal Medicine, and he joins us now. Welcome to the program.

NORRIS: I'm happy to be here.

NORRIS: How did you go about this study, in trying to figure out if there was something to this July effect?

NORRIS: Well, I looked at about 250,000 medication error deaths over a period from 1979 through 2006, and no one previously had been able to look at such a large sample of deaths. And I think that may be one reason why no one previously had found this July spike that we did.

NORRIS: And did you, as I understand, compare counties without teaching hospitals with counties that actually had teaching hospitals?

NORRIS: Yes, that was one of the things we did. And we found that this spike in July deaths from medication errors appears only in counties that have teaching hospitals. And you find this July spike in medication error deaths, but you don't find any equivalent spike in July in any other cause of death.

Deaths from medication errors are increasingly frequent, and it's now true that accidental deaths from medication errors constitute the second leading kind of accident in this country. Only motor vehicle accidents are more frequent.

NORRIS: So your conclusion is that there really is a July effect?

NORRIS: Well, inside these counties that have teaching hospitals, and inside the hospitals in those counties, medication error deaths spike by 10 percent above expected in July. And you don't find any equivalent spike in deaths outside the hospital, or in deaths from other causes - aside from medication errors.

NORRIS: So we mentioned that there is inexperience, that that might be a factor. Sleep deprivation might be another factor. Is there anything that could possibly be contributing to this?

NORRIS: Well, I think that surgical residents are also inexperienced in July. But in contrast to medical residents, the surgical resident is part of a team, which provides multiple checks on possible errors. But the medical resident often is working alone.

NORRIS: You conclude that this is a significant national health problem. What should be done about it?

NORRIS: Well, fortunately, the spike is only in July, so the problem seems to be localized to just a 30-day or 31-day period. So I think that it would be reasonable to ease the medical resident into these responsibilities, and not just suddenly dump them on the medical resident.

It would be useful to alert medical residents and indeed, other staff about this problem with medication errors. And it would be useful in general to educate medical staff and indeed, patients about the problems with medication errors.

I think that one thing that patients could do would be not to go in, in July if they have some kind of medical problem that is not urgent but can be scheduled in a variety of times. Then they might want to consider going in, in August rather than in July.

NORRIS: Professor Phillips, though, I imagine there are people listening to this who do have medical procedures scheduled for July, or have loved ones that are planning to head to the hospital soon. Is there anything they can do to protect themselves?

NORRIS: Well, what I would do - and I think I would do this in whatever month I was in the hospital - is, I would firmly and assertively and politely ask medical staff to double-check on the medicines and the dosages that are being provided. And if I were not able to do that - perhaps I was unconscious or in some other way incapacitated - I would ask an advocate to come in with me and do that checking.

NORRIS: David Phillips is a professor of sociology at the University of California at San Diego. Professor Phillips, thank you very much.

NORRIS: Sure, my pleasure.

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