Why hospital death rates jump in July

In most U.S. teaching hospitals, medical students, interns, and residents move up to the next level in July. The same thing happens in the United Kingdom in August. According to a May 12 article from Politico (link), this makes July and August bad months to get seriously sick in those countries, because medical errors take an upward jump, by 6 to 8 percent in Britain and by 8 to 34 percent in the U.S.

(I’m vaguely reminded of something a resident in internal medicine at Duke told me back in the early 1980s: He’d received a phone call from an orthopedics resident who said he’d just given a patient 10 units of folderol, or whatever it was, and asked, “Was that a good idea?” The internal medicine resident replied, “Don’t do anything. I’ll be right there.”)

The article also mentions the fancier treatments VIPs can get. I have no particular problem with this provided the difference amounts to fancier accommodations that the hospital charges for and then uses the profit to provide better care for everyone. But it’s another matter when, for example, hospital staff is shifted from where they’re more needed to VIP floors to provide the rich with unnecessary one-on-one nursing. There are some people who think medical is just like any other service, but I think more of us are uncomfortable with the notion that middle class and poor people are less deserving of life-saving care.

The article is based on a book titled The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital by Alexandra Robbins, based largely on conversations with nurses, who probably know more about the realities of patient care than anybody.

Fortunately, though the article doesn’t mention it, there are people in the medical profession who do take these problems seriously and are trying to do something about them. The overall rate of hospital errors in the U.S. has declined, and that rate has accelerated because of some little-known provisions in the Affordable Care Act. (See this previous article.)

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