July is Most Dangerous Time for Surgery: San Francisco Foot Surgeon Explains

Your chances of dying in a hospital are highest in July. A new study published yesterday in the Journal of General Internal Medicine exposes one of medicine’s dirty little secrets. It has long been known that all medical internships, surgery residencies, and fellowships begin on July 1st every year. Because of this, July may be the riskiest month for you to have foot surgery or any other procedure that might be associated with hospitalization.

This is not complicated. After eight years of sitting in college classrooms and medical school lecture halls, the wet-behind-the-ears medical intern is just plain itching to practice all of those skills he or she has read about. The problem is, they have a lot of learning left to do.

You don’t really want to be the first person when a new foot doctor tries to make a surgical incision on your foot. You don’t want to be a new ankle surgeon’s very first ankle ligament repair surgery. You also don’t want to that new, nervous, over-worked and sleep deprived intern fumbling through a Pharmacy handbook while writing your medication orders at 4:00 a.m.

It is this combination of pressure and inexperience on new doctors in training that produces the “July Effect.” This new study conducted at large teaching hospitals in California (but not in the San Francisco Bay Area) found that fatal medication errors spiked by 10% during the month of July in counties that had teaching hospitals. By contrast there was no increase in medication errors in counties that did not have doctor’s in training. The study concluded that the spike in hospital deaths was in large part associated with the influx of new medical resident doctors in the month of July.

Whether you are considering bunion surgery or back surgery, there are some simple steps you can take to avoid the risks associated with new medical residents.

1) Have surgery in June or August instead of July. The most change in staff happens in July. This is when the medical residents are newest and more likely to make errors. They are also more likely to get in over their heads in surgery.

2) Avoid the teaching hospitals in July. If you have an elective procedure (such as bunion surgery, ankle stabilization surgery, or heel spur surgery) request that the procedure be performed at an outpatient ambulatory surgery center. There will be fewer residents and less chance of a newbie bungling your case.

3) Ask questions! You have a right to understand all of the procedures that will be done, and by whom. Ask if a resident will scrub in your foot surgery. You do have the right to refuse to have doctors-in-training involved in your care. By asking questions about your surgery, postoperative care, rehabilitation and medications, you will force the attending doctor to stop and think. This may decrease your risk of an error that could occur if the doc is hurried.

4) Have an advocate on your side. If you have a concierge type physician caring for you and overseeing your care, it is far more likely that any mistakes will be caught in time. Docs that report to other docs will be more focused and paying closer attention. If you don’t have a concierge-type physician, at least bring a family member who can ask lots of questions and take notes.

5) Choose an “Out-of-Network” Surgeon. Don’t expect concierge care if you have Medicare. This is just math. On June 1, 2010 doctor’s who accept Medicare got a 21% pay cut. They will be moving faster and working harder to pay the light bill. This will quickly trickle down to all “In-Network” Insurance Policies. Most insurance contracts with “In-Network” doctors are based on a percentage of Medicare pay rates. By choosing a doctor who is “Out-of-Network” you will get a doctor who has more time to spend with you, answer your questions, and guard against resident-associated errors.

The more you know about the dangers of medication errors and inexperience associated with the annual medical trainee change-over in July, the more empowered you will be to enter the hospital or operating room and have a successful surgery. But if you have to check into a University Teaching Hospital in July, stay low and keep moving!

Dr. Christopher Segler is a San Francisco based foot surgeon and an award-winning podiatrist. His new patient appointments with foot surgery patients generally take 1-2 hours. He thinks the best medical care is personalized convenient care. He makes house calls and does not allow residents to perform surgery for him. He also takes his patients to reputable outpatient surgery centers. If you have a question about foot surgery, you can call him directly at 415-308-0833. Learn more at San Francisco's Foot Surgery Info Site.