Residents' inexperience, fatigue concern physicians and the public

A new study by researchers at University of California at San Diego provides some of the hardest evidence yet for a phenomenon physicians have long referred to as the "July effect": a spike in medical errors when new residents join hospitals.

Unlike many previous studies that have looked at small, non-geographically representative samples over a limited time period, social scientist David H. Phillips of UCSD, together with graduate student Gwendolyn E. C. Barker, studied all 62,338,584 U.S. death certificates for the period 1979 to 2006, ultimately focusing on 244,388 deaths linked to medication areas, reports the Los Angeles Times. They found an average increase of 10 percent in medication-linked deaths in July in counties with teaching hospitals, but none in other counties--with the most deaths in areas with the most teaching hospitals.

Studying deaths outside the hospital, the researchers found no similar spike in deaths during the period, suggesting that it was not simply a summertime phenomenon. They found no spike in deaths not related to medication errors during July, however.

Even without the study, anecdotal belief that July is a bad month to be hospitalized has been strong. Phillips divulged to the ScienceNews that a physician, not aware of his research, had told him, "If possible, you should probably avoid going in [being hospitalized] during July."

And while doctors are leery of residents' inexperience, the public wants more done to ensure that medical students are alert while providing healthcare. A new survey published in the online journal BMC Medicine reveals that 90 percent of Americans believe the maximum shift duration should be 16 hours. Current standards allow for 30-hour shifts up to two times a week, notes MedPage Today.

Thus, the "stark discrepancy" between what the public wants and how many hours residents actually work is a cause for concern, said the study authors, led by Alexander Blum, MD, of the Department of Health and Evidence Policy at the Mount Sinai School of Medicine in New York City.

Half of all hospitalized patients receive medical care from 108,000 resident doctors at teaching hospitals, noted study co-author Charles Czeisler, MD, professor of sleep medicine at the Harvard School of Medicine. During a recent press conference to discuss the survey, he said, "One of five resident physicians admits to making a fatigue-related error that has injured a patient, and one in 20 admits to making a fatigue-related error that has resulted in the death of a patient."

To learn more:
- read this article in the Los Angeles Times
- see this piece in ScienceNews
- check out this story in MedPage Today
- see this abstract in BMC Medicine