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There's Good News if You're Worried About Death-by-Hospital in July

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Every year hospitals and patients worry about the “July Effect,” a rumored increase in complications and deaths in that mid-summer month. Learn why the July Effect supposedly exists, and why it may not be as bad as people fear.

Every July, medical students pour into hospitals to start their life as interns. Meanwhile, last year’s interns graduate to a new level and start assuming higher levels of responsibility. Like everyone else in the world, doctors are relatively unskilled when they start their job. This is unavoidable. If we want doctors to learn, we have to give them the chance to practice. It does mean that during July, people with real problems are being treated by experts with education, but without much experience. This, according to some, leads to significant risk of death.

The July Effect is hard to measure, because so many different factors affect an outcome. Some have blamed the effect on tourism (tourists tend to get worse care), Fourth of July accidents, and increased alcohol consumption in the summer. Not everyone is buying that. One alarming study published in 2010 showed that fatal medication errors went up 10% in July, and did so only in teaching hospitals.


There are problems with the July effect, though. One is the fact that complications don’t seem to go up as much as fatal errors. Are people only being killed and not being injured? There’s also some recent studies, done in specific areas of medicine, that don’t show the July Effect at all.

One such study was just published in the Journal of Neurosurgery. It shows that mortality simply doesn’t go up in neurosurgery, whether it was caused by error or not. There were some differences, though. Second and fourth year residents tended to do more blood transfusions in July. Fifth and seventh year residents tended to need to re-operate. These were differences not seen in community (non-teaching) hospitals. Still, the death rate did not differ significantly between teaching and community facilities. While no one wants any errors, no one has to worry about death-by-July in neurosurgery.


These results from this study mirror the results of another study done in cardiac surgery, which showed no increase in mortality in July. The main drawback of a July procedure, according to that study, was a slightly longer operating time.

So does the July Effect exist? It seems to differ depending on the area of medicine being practiced. If any physicians are reading this, I’d love to hear their opinions on whether or not the July Effect is real, and if so, what causes it.


Image: Anita Mishra