July is the time when senior residents at hospitals move on to other work and new residents start their first roles as doctors in the medical field. Over 30,000 new residents and other trainees enter the medical field during the month, which may make this season of change a bad time to visit the hospital.

Understanding the July Effect

Many studies have attempted to evaluate this so called “July Effect.” The larger studies with more consistent research methods do point to a trend of the quality of care decreasing and mortality rates increasing during this time. At teaching hospitals, some studies indicate the risk of dying is 4-12 percent higher in July.

In one study, 62 million death certificates from 1979-2006 were evaluated for medication error-related causes of death. The study highlighted July as the only month of the year with an observed-to-expected death ratio of over 1.00. The study did not look at other error-related causes of death, but it paints an alarming picture nonetheless.

Cause and Effect

Although some of the larger studies present a clear correlation, correlation is not causation, and measuring the July Effect is a complex process. Many in the medical community highlight conflicting studies which may or may not accurately represent the entirety of the theory.

The shifting of residents does not affect your primary care physician in the hospital, but new residents learning the ropes are often the ones attending to patients on a regular basis. Since a 1999 study highlighted as many as 100,000 deaths in hospitals each year due to medical error, the industry has been trying to create a safer environment. In an effort to reverse these alarming trends, many hospitals, increasingly aware of the toll long hours have on doctors and residents, are improving safety standards across the board.

Since the issue is so complex, there are some ways you can protect yourself from experiencing a medical error. Your risk during most ER trips and hospital visits is negligible, but extra caution is always a good practice, particularly until this phenomenon is better understood. Here is a sampling of what you can do:

  • Avoid teaching hospitals. All of the most rigorous studies reviewed in the industry recently have corroborated the concept of the July Effect, but only for hospitals where new residents were beginning their practices.
  • Take someone with you. Take a friend or relative to act as your patient advocate at the hospital, particularly if you are having surgery or are undergoing a major procedure. Encourage them to ask questions and become very involved with the process.
  • Ask LOTS of questions. Double-check everything you are handed. Medication errors can cause serious complications very quickly. Ask your doctor what medications you will likely be prescribed, what they should look like when you get them, and how they should affect you. Ask nurses and doctors why they are performing certain tests and exercises to make sure you are being treated for the appropriate reason.
  • Ask about the hospital’s oversight program. Learn as much as you can about the safety standards at the hospital where you will be staying. You should feel comfortable that the hospital you visit is putting your best interests first.

Even though residents and interns may be new in July, they are all acting under the guidance of a practicing physician. If a new resident or intern is working with you, increase their comfort level by introducing yourself. Putting them at ease can also increase the level of care you receive. Talk to everyone who comes into your room, and understand the hierarchy of those who will be caring for you during your stay. Medical malpractice can occur any month of the year so it is important to be proactive in your own healthcare.