Danger: white coats

Doctors call it 'the killing season': the time in August when keen, but as yet unskilled, young medics are first let loose on the wards. Be very afraid, says Daniel K Sokol

In 1714, the poet Matthew Prior wrote, "Cur'd yesterday of my disease, I died last night of my physician." In Prior's day, patients were as likely to be killed by their doctors as cured by them. Medical treatments, from blood-sucking leeches to oil of earthworm, usually aggravated the disease rather than improved it. Nowadays, doctors are far more effective in treating patients. Yet, each August, rumour goes that we should stay away from hospitals. For several weeks, our hospitals acquire the same reputation as the plague and leprosy-infested lazarettos of the Middle Ages. So perilous is the hospital experience that August has been dubbed "the killing season" by doctors throughout the country. But what lies behind this macabre rumour?

In 1714, the poet Matthew Prior wrote, "Cur'd yesterday of my disease, I died last night of my physician." In Prior's day, patients were as likely to be killed by their doctors as cured by them. Medical treatments, from blood-sucking leeches to oil of earthworm, usually aggravated the disease rather than improved it. Nowadays, doctors are far more effective in treating patients. Yet, each August, rumour goes that we should stay away from hospitals. For several weeks, our hospitals acquire the same reputation as the plague and leprosy-infested lazarettos of the Middle Ages. So perilous is the hospital experience that August has been dubbed "the killing season" by doctors throughout the country. But what lies behind this macabre rumour?

In the first week of August, hundreds of newly qualified doctors are unleashed on British hospitals. The term "killing season" is based on the belief that the new doctors, armed with much goodwill but scant practical skill, are responsible for an increase in fatalities in their first month as house officers.

So is there any truth in the "killing season"? The anecdotal evidence is certainly far from comforting. One newly qualified doctor, in charge of his first cardiac arrest, misplaced the defibrillator pads above the patient's bladder. The result was a non-beating heart and a violent emission of urine that drenched the neighbouring nurse.

During another cardiac arrest, a junior doctor noticed some erratic heart rhythms on the monitor. Puzzled but confident, she applied the electric shocks, which matched the changing cardiac rhythms. When, despite her best efforts, the patient died, she realised that the monitor had been set on "teaching mode". In this mode, the monitor displays random heart rhythms to test the knowledge of medical students. The patient had, therefore, received several inappropriate sets of electric shocks.

Yet anecdotes are no guide. In 1994, a study in the British Medical Journal compared the number of deaths in UK hospitals in the last week of July, when the new doctors are still enjoying their post-exam holidays, with deaths in the first week of August, when they are let loose. It found that there is as much "killing" in July as there is in August.

One weakness in the study is that many senior doctors go away on holiday during the summer, arguably increasing the number of deaths, but a large American study published last year confirmed the British results: that mortality rates and length of stay do not change significantly from month to month.

But, inevitably, new doctors are more prone to mistakes than more experienced doctors. "Of course they're more likely to make mistakes in their first few weeks," says Mr Ashok Handa, a consultant surgeon and tutor in clinical medicine in Oxford, "but they're closely supervised."

This is one way in which the situation has changed from 20 years ago, when new doctors were often left to fend for themselves. The "I-went-through-hell-and-so-will-you" mentality has been replaced by a more supportive attitude among current doctors. New recruits are actively encouraged to ask for help if in the slightest doubt, and senior doctors supervise or double-check procedures.

Another major shift from 20 years ago is in the medical training of new doctors, which now contains a much larger practical component. In many medical schools, students cannot qualify without completing a course on advanced life-support and on recognising acute life-threatening conditions. Also, for two weeks, medical students in their final year shadow junior doctors.

Although the "killing season" may have had elements of truth in the past, it is today no more than a joke among medics. New doctors are better trained than ever. So if you do have a serious accident this month, do not think twice: call an ambulance.

Daniel K Sokol is a medical ethicist at the Imperial College Faculty of Medicine, London

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