By CORY FRANKLIN M.D.

So in their first week of formal training, residents are sent out to work in an environment with less staffing and fewer specialists. Most good hospitals are aware of this anomaly and provide extra coverage accordingly.

     One of the urban myths that frequently circulates is that July is the worst time to be sick due to the inexperience of the staff. Most studies that have looked at this tend to refute it—mortality is not higher in July. In my hospital’s department of medicine, I studied mortality figures for nearly three decades, and there was no July increase in mortality. Some observers have theorized August may actually be a more dangerous month, since the inexperienced doctors are now on their own more often, no longer backed by extra coverage. Others have postulated June as the most dangerous month, since so many resident doctors are leaving at the end of the month and might have a tendency to “slack off.” There is no evidence to support either of these theories.   

    Based on my observations, I believe these theories are invalid because physician experience, while a variable in hospital outcome, is at best a minor factor. Far more important than physician experience in determining hospital mortality is case-mix, the type of diseases and patients who compose the hospital population. The highest mortality in our medical department was usually not in the summer, when physicians had less experience, but in the winter when there were far more communicable respiratory problems such as pneumonia and influenza. For us, the Christmas season was a more dangerous time than July 4. (Of course, mortality soared during the summer heat wave of 1995 when the hot weather was a major cardiovascular stressor.)               

    Conversely, my surgical colleagues did tend to see a higher mortality in the summer, but it was almost certainly due to the increases in blunt and penetrating trauma that occur in the summer months. In the summer, more people are outside and that brings a concomitant increase in motor vehicle accidents, arguments and all the dangerous behavior that results in serious injury. July is a more dangerous time for surgical patients and sometimes even the most experienced surgeon can’t put Humpty Dumpty back together again.                                        

    Holidays change the make-up of patients entering the emergency room. Most people put off the routine problems that would ordinarily send them to the hospital. (One ER doctor once told me he thought the slowest evening of the year was that All-American holiday, Super Bowl Sunday. It sounds good, but I have seen no evidence to confirm it.) What it does present to the hospital on holidays is what you’d expect—carving and cooking mishaps and injuries from outdoor athletic activities during summer holidays. Several studies have noted a greater incidence of depression during the holidays. And of course, alcohol, lots of alcohol.  

    A person who works with organ transplant candidates told me a fascinating story about holidays in the hospital. Transplant candidates often get their organs from victims of motor vehicle accidents, and since there are more fatal crashes during holidays, some of these potential recipients have admitted experiencing a subtle stirring of morbid hope during the holidays. (According to the National Highway Traffic Safety Administration, the five most dangerous holidays for drivers, in order, are Thanksgiving, July 4, Memorial Day weekend, Labor Day weekend and New Year’s Eve/Day.)                           

    However abstract it seems, organ recipients know somewhere out there on Thanksgiving weekend a motorcyclist going too fast or a car versus tree collision will result in a donatable heart, kidney or liver. The flip side is that once the holiday is over and they did not receive a call, they become slightly depressed over the lost opportunity. I have never seen literature to support this phenomenon, but there is a certain logic, however perverse, at work.                                          

    When it came to holidays, drama and emotional pull, Billy Wilder had it exactly right. A long-time colleague told me a poignant story about working in the hospital during Christmas. He was the anesthesiologist working on-call for the operating room one year on Christmas Day. It was slow day; there wasn’t a single case. So everyone—the surgical team, nursing staff and orderlies—sat around the lounge playing Monopoly. As he described it, I imagined lots of Santa hats on people who would rather have been with their families. Perhaps an uneaten fruitcake on the table next to the Monopoly board. Though it happened many years ago, he still remembers it vividly. He confided with a sly wink, “That day I learned the true meaning of Christmas—buying Boardwalk and Park Place.”