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Don't Get Sick in July

August 2010

Sidney M. Wolfe, M.D.

For those of you who are planning to go to the hospital for diagnosis or treatment but have not yet gone, breathe more easily, now that July is over.

A study just published in the Journal of General Internal Medicine (JGIM) examined death certificates of 244,000 people who had died in the U.S. between 1979 and 2006 because of medication errors. The authors found that inside medical institutions such as hospitals, in counties containing teaching hospitals, fatal medication errors spiked significantly, over what was expected, by 10 percent in July and in no other month. In contrast, there was no July spike in counties without teaching hospitals. These findings held only for medication errors, not for other causes of death such as surgical errors.

Why is this happening? Each July more than ten thousand new doctors begin medical residencies in teaching hospitals, thereby having more responsibility for treating patients. Although it has been suggested for a long time that these new medical residents may make more mistakes resulting in worse patient outcomes, often referred to as the “July Effect,” there has previously been no U.S. evidence documenting this.

In an accompanying editorial, JGIM Co-Editor Dr. Richard Kravitz wrote:

The accumulated evidence on the “July spike” is probably convincing enough to prompt action: for example, having attendings or senior residents “in house” during extended hours, conducting rounds twice a day (as pediatrics has done for decades), or just making sure adequate help is available at the point of care. Academic general internal medicine doesn’t shut down during the dog days of summer. Our resolve to improve the quality of hospital care shouldn’t shut down either.

We couldn’t agree more!

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