MEDICAL MATTERS:Referring to interns' 'killing season' is unfair, writes MUIRIS HOUSTON
IT HAS infamously been called the killing season by a senior executive in the National Health Service (NHS). A reference to the changeover of junior doctors that occurs every summer, when newly qualified medical graduates begin to work as interns, it occurs in early August in the UK.
Readers in Ireland can breathe a sigh of relief; July 9th was changeover day in the Republic, so if you were in hospital last week and you are still alive then you have survived the apparently murderous intentions of all new interns.
Sir Bruce Keogh, NHS medical director, said recently that patients were at risk during this period. Referring to a decision to make it compulsory for all junior doctors to shadow senior colleagues for the first four days of their new appointment, “the intention is to end the so-called killing season”, he said. “This is good news for patients – we recognise the changeover period puts patients at risk.
“Junior doctors are under stress as they change from being a student to a professional, and they need help to adapt to a working environment when they’ve never done a job before.”
However logical his proposal – on the face of it being held by the hand for the first week of any job sounds like an undeniably “safe” thing to do – I do not agree with his use of language. Referring to a “killing season” in hospital wards is, in my opinion, potentially harmful to patients and deeply unhelpful to what is supposed to be a healing process.
Unfortunately, the media are firmly in the grip of an unquestioning “incompetent junior doctors put patients’ lives at risk” narrative. So don’t be surprised if this column is one of the few places where you will see a reference to a study published by Renée M van der Leeuw et al in BMC Medicine last week.
In a review of the medical literature from 2004-2011, the study seeks to identify correlations between aspects of residency training and patient outcomes. Residents are the US and Canadian equivalent of our interns and senior house officers. The study was an international one and so has a relevance beyond North American shores.
The study found residents become more efficient in practical procedures as their training progresses. And it concluded those nearer the end of their training tend to score more highly on patient satisfaction and have better patient outcomes than those starting out. All very much as you would expect.
But the overall message was that the clinical care received from doctors still in training is not only safe, but comparable with care provided by their more senior counterparts. Certainly, junior doctors must be provided with the required supervision to achieve the same level of outcome as their more experienced seniors, but this is the case in any discipline: whether it be student teaching, becoming a competent lawyer or a chef.
It is also worth pointing out the centuries-old tradition of the apprenticeship model in medical training. Most of a doctor’s practical training, such as acquisition and honing of clinical and diagnostic skills, as well as the example of such desirable attributes as personal commitment to actual patient care, were derived from senior colleagues or mentors. The acquisition of competency was wrapped up in that of professionalism in a close “master-apprentice” learning model.
Sure, there have been studies showing, for example, that patients admitted for emergency treatment at weekends were almost 10 per cent more likely to die than those admitted during the rest of the week. And there are pilot studies to show mistakes made by newly qualified doctors were reduced by 50 per cent after a week of shadowing became mandatory.
But conflating this to war-like language is deeply unhelpful. It simply doesn’t help patients, who for the most part cannot decide when they will be sick enough to require hospital admission. And it does nothing for the junior doctors on the road to becoming the specialists of tomorrow.
Saying this, I won’t be taking bets on headlines changing to “junior doctors usually perfectly competent” any time soon.