22 Sep 2011


A recent meta-analysis confirmed the “July effect”. [Young et al. Ann Intern Med 2011;155-309-15] During changeover to a new group of interns, mortality of in-patients increases by 4-12%. This is accompanied by an increase in medical errors and prolongation of hospital stay.

It is often a relief to note that terrible things do not occur only locally. On the other hand, the fact that “July effect” is genuine and widespread is disconcerting. If a disease is causing deaths of this magnitude, it would have drawn a lot of attention. New treatments would be developed and introduced every year. The same does not apply to human errors. Professionals tend to accept that it is natural and inevitable that newcomers would commit errors.

While I was pondering this question, KM joined us for lunch. “I have a new proposal,” he announced. “Let’s ask interns to take care of all emergency cases. To ensure compliance, we can assign whole day clinics to on-call medical officers. The cases would then be reviewed only by the physicians in the evening.”

LS was speechless. After a while, the intern coordinator finally said, “But our patients will die!”

“Interns are supposed to see emergency cases now,” reminded my mentor. “Why do we have to change?”

“I was approached by an intern,” KM explained. “She wished to see emergency cases, but said she could only do so if we put it as a policy.”

“Why?” all of us asked. “If she is eager to see the cases, who would stop her?”

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