Between the nerves, the unfamiliarity and the urge to impress, few people do themselves justice on the first day of a new job. When it comes to doctors starting out in emergency medicine, though, are patients' lives being put at risk? According to research from Imperial College London, the death rate among patients admitted to English hospitals on the first Wednesday in August the day, traditionally, that newly graduated doctors take up their posts was, on average, 6% higher than for those admitted the last Wednesday in July. An influx of new medical staff, in other words, just might be very, very bad for your health.
In the university's study (the biggest of its kind so far), published Sept. 23 in PLoS One, the online scientific journal of the U.S. Public Library of Science, scientists analyzed close to 300,000 patients admitted to state-run hospitals across England on those two Wednesdays from 2000 to 2008. The health of the patients, who were split evenly between the July and August admission days, was tracked for a week. While there was little difference between the crude death rates for each seven-day period, when researchers controlled for the patients' age, sex, socioeconomic status and secondary medical problems, the odds of dying was found to be 6% higher for those admitted on the Wednesday in August. Among so-called medical admissions all those not suffering from cancer or requiring surgery the odds were 8% higher.
Should patients be nervous? Scientists have for years been examining the patient risk associated with a changeover of medical staff. Smaller studies conducted over the past two decades in Britain and the U.S. where researchers label it the "July phenomenon," after the month in which medical students usually begin training have often proved inconclusive.
Even the "small but significant" discrepancy highlighted by Imperial's study doesn't point to a particular cause. It's possible that patients admitted on the days junior doctors began work were simply in worse health than those taken in the week earlier. Some hospitals may have been more reluctant to admit patients with less-serious problems on the days new staff started work, limiting the number of cases young medics had to deal with but increasing the concentration of acutely ill patients in the process. "So it may not necessarily be directly related to the quality of care," says Paul Aylin, an epidemiologist at Imperial College London and senior author of the study.
Aylin and his colleagues are keen to test the link further. One problem: tracking admissions for a longer period before and after junior doctors begin work might offer a more reliable sample; extend the monitoring period too far, though, and the two groups soon overlap. Plenty more for researchers to ponder, then except those on their first day.