White Coat Underground

The medical education calendar begins and ends on the first of July each year, and in the hospital, that means a brand spanking new crop of young doctors. While this may sound a bit scary, the facts are a bit subtle (and not terrifying). Some of the questions regarding the so-called July Phenomenon are:

Are hospitals more dangerous in July?
Is care more expensive in July?
Are hospital stays longer in July?

The data show that there does not appear to be an increase in poor outcomes in July vs. other months, but in some fields hospital stays may be longer and care may be more expensive due to increased utilization of tests.

Most of the data that support a July phenomenon in hospitals aren’t all that strong, indicating that it’s unlikely hospital care is significantly different in July vs. other months.

July is fun though. New doctors are excited to learn and to work, and soak it up like sponges, except in crisp white coats.

References

Rich, Eugene C.; Hillson, Steven D.; Dowd, Bryan; Morris, Nora. Specialty Differences in the ‘July Phenomenon’ for Twin Cities Teaching Hospitals. Medical Care. 31(1):73-83, January 1993.

Barry, W., & Rosenthal, G. (2003). Is There a July Phenomenon?. The Effect of July Admission on Intensive Care Mortality and LOS in Teaching Hospitals Journal of General Internal Medicine, 18 (8), 639-645 DOI: 10.1046/j.1525-1497.2003.20605.x

Myles, Thomas D. Is There an Obstetric July Phenomenon? Obstetrics & Gynecology . 102(5, Part 1):1080-1084, November 2003.

Ford, A., Bateman, B., Simpson, L., & Ratan, R. (2007). Nationwide data confirms absence of ‘July phenomenon’ in obstetrics: it’s safe to deliver in July Journal of Perinatology, 27 (2), 73-76 DOI: 10.1038/sj.jp.7211635

Comments

#1 Orac
July 1, 2009

You forgot one:

Englesbe MJ, Pelletier SJ, Magee JC, Gauger P, Schifftner T, Henderson WG, Khuri SF, Campbell DA (2007). Seasonal variation in surgical outcomes as measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Ann Surg. 246(3):456-62.
#2 PalMD
July 1, 2009

Thanks, man
#3 Whitecoat Tales
July 1, 2009

July is fun though. New doctors are excited to learn and to work, and soak it up like sponges, except in crisp white coats.

Not just the new doctors!
Alll the med 2s are starting on the wards. And all the med 3′s are med 4s. All us young minds, waiting to drink from the firehose of knowledge that is the wards!

Not to mention adjusting to the hours, in two months I went from saying “crap 8am lectures are waaayyy too early, and an 8 hour day is so tiring” to “wow I only had to get in at 5:30am , and I’m home before 6pm, today is AWESOME”
#4 mxh
July 1, 2009

Not to mention adjusting to the hours, in two months I went from saying “crap 8am lectures are waaayyy too early, and an 8 hour day is so tiring” to “wow I only had to get in at 5:30am , and I’m home before 6pm, today is AWESOME”

Yeah, or in my case, the reverse. Looking forward to starting in 5 days.

…and the papers are interesting. I was always wondering if July is a bad time to be hospitalized.
#5 Tsu Dho Nimh, BS, MT(ASCP)
July 1, 2009

During their orientation, before they were turned loose, the new residents and interns where I was working got a sampling of every diagnostic that could safely be done … even had to swallow the chalky stuff for the upper GI xrays.

We drew blood multiple times that week: once for their hemo, once for the sero, once for the blood typing, once for the chem … and in orientation they were told that it could all have been drawn with a single needlestick, but wasn’t, because “that’s the way the orders were written”. It made them think twice about how they wrote things.

And they got to eat breakfast, lunch and dinner in the conference rooms: first day was clear liquids which they sipped while the dietician went over what it was used for. Next day was bland, then salt-free, and worked their way up to the usual menus. I would have started them with NPO, but I’m a big meanie.
#6 murali
July 1, 2009

Today was the first day of my fellowship….pulm-crit care and in the ICU….scary!
#7 Mu
July 2, 2009

That’s probably a bit like first day of organic chemistry lab. So nowadays you don’t get to play with liquid sodium in the base lab anymore. Luckily they can’t dumb down medical education as badly as they’ve done to the hands-on part in chemistry, there’s no “minor aches and pain” ward in the hospital.
#8 Beth
July 2, 2009

Man, now you’ve got me imagining sponges in crisp white coats. (Well, I can only manage to imagine one, but still.)

I didn’t know that, but I’d think the longest stays (with nothing much happening) would be around the holidays. If nothing else, there’s that whoever’s there generally doesn’t want to be there.. and then there’s the issue of whether techs are there.. and is this important enough to drag the doctors or the techs (who aren’t there) away from whatever they’re doing? Sure, they’re on-call, but do we really need to? Yeah, I can imagine things going slower then. (I was almost in the hospital on Thanksgiving once. Luckily was able to get the rest of my IVs out-patient.)

Do nurses, phlebotomists and such just come and go whenever? (The other day, I heard nurses collaborating on an online test. Even just giving someone else the answers. That’s a little disturbing.)
#9 The Blind Watchmaker
July 3, 2009

I remember that first day well. It was the best of times, it was the worst of times. Exciting for sure.
#10 Catharine
July 3, 2009

July is not too fun for nurses. But it is funny. A conversation today between two interns:

Intern A: “I’m going to the cafe. Do you want me to bring you anything?”

Intern B: (with the exasperation of a critical care veteran)*sigh* “Yeah. Bring me some nuggets.”

Poor intern B. What he wanted, what he needed, was a Happy Meal.

At least once every July a fresh white coat will pull me aside and say, “Please, don’t let me kill anyone!” These are the docs that are going to be really good. They know what they don’t know. The ones who “know everything,” on the other hand, are dangerous.

Beth: Nurses are your best friend. Learn that now, be you doctor or patient. I’m not quite sure what you mean by “nurses, phlebotomists, and such.” Do you think that there are two categories: Doctors and everybody else? You are bothered that the “and such” people “come and go whenever?” Doctors and nurses have different roles. Doctors are NOT “in charge” or “the boss” of nurses (or anybody else). Usually we work together in harmony. We have the common goal of a good outcome for our patients. And before you judge nurses too harshly for collaborating OR EVEN CHEATING on some online nonsense, you should familiarize yourself with the nature of that particular nonsense. I guarantee you it wasn’t a nursing board exam. Nurses, like doctors, learn from each other. So what?

Despite the bungled orders, unnecessary tests, learning curve and general clumsiness, July is a great month. Every year I am inspired by the energy, intelligence, enthusiasm and commitment of the new (clean) white coats. What is shocking is how the white coats keep getting younger (so much younger!) every year.