by George Aitch
The day is slowly creeping near; the last exam has been sat, the graduation gown has been rented and all my paperwork (reams and reams of the stuff) has been sent off. Everything I’ve been working towards for the last decade of my life is about to be realised. Soon I’ll hit the wards as a junior doctor. Although the thought does make me nervous, by and large I’m on cloud nine.
That is until I hear one of my friends say “so when is Black Wednesday?”. Instantly the bubble bursts. ‘Black Wednesday’, a hackneyed phrase popular in the press, refers to that first Wednesday in August when newly graduated doctors start work (see also: Killing Season, tastefully coined by Sir Bruce Keogh). As well as an alleged spike in medical errors, we also see a spike in scaremongering stories. But how much truth is there in Black Wednesday? Are my future colleagues and I menaces to patient safety?
The numbers behind the name
Oft quoted are “studies” (without links, sources or citations) pointing to a 6-8% increase in mortality on graduates starting date than the previous Wednesday as well as fewer patients being admitted from A and E. If you dig enough, you can find the lone study cited which covers data from 2000-9. But there is a problem here; if a smaller number of patients are admitted on that particular day, perhaps in part because they have read somewhere that their chances of dying are higher (what an effective triage!), then only the really sick will attend the emergency room. Another explanation I have heard is that many members of staff, not wanting to work with fledgling doctors, take that week off – less competent and full time staff surely contributes to a death rate? Perhaps, as the BMA points out, it is best not to smear seven thousand professionals at once.
If these factors are not excluded by the study, then it may explain away the 6% jump, which amounts to five extra deaths nationwide in that period. Even the study’s authors stated that this was very low. That’s not say that these statistics aren’t significant (they are, just) or that those extra deaths weren’t tragic – it’s just that without a breakdown of causes those deaths, we cannot say for sure that the new cohort of doctors was responsible.
But this data is now nearly ten years old. Since this was reported, measures, such as shadowing senior figures, moving induction days and staggering when speciality doctors start, have been brought in to improve patient safety (though we now change jobs more often). So why is the phrase ‘Black Wednesday’ still thrown around? Although pilot studies testing changes made in 2012 showed that these July Effect deaths were reduced by 50%, there have not been any large scale studies examining for a nationwide reduction. This does not stop many sources still quoting these out of date statistics, however.
Other threats to patient safety
I note that in mentioning these ‘threats’ to patient health, other sources of danger towards patients are not highlighted. The Daily Mail does very little to discuss the asset stripping and managed decline of the NHS. The Guardian took months to report the Junior Doctors’ Contract dispute. Sir Bruce Keogh continues to get cosy with Jeremy Hunt, who is still Health Secretary despite being the biggest threat to patient safety. Where is the moral outrage here? Even an impartial discussion on BBC Radio 4 would be nice.
In my own experience, I have had the benefit of a wonderful assistantship programme while at medical school. We spend six weeks shadowing other foundation doctors and learn the ropes from them, the sorts of skills and tips which we can’t pick up from lecture theatres and textbooks. Could such a great scheme be rolled out nationwide perhaps, to prevent these five unnecessary deaths per year?
On the whole, I am sure that this cloud of fear generated by the British media does more harm than good. So business as usual then. This August, 7000 doctors hit the wards for the first time. Except it isn’t; we’ve had our experience in medical school doing this. The game has changed slightly – our signatures matter now. But that medical degree isn’t given for nothing. Referring to the starting day as ‘Black Wednesday’ is an ingratious slur which reflects poorly on those who use the term rather than those keen new doctors at whom it is directed.
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Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing. All data is based on externally validated studies unless expressed otherwise. Novel data is representative of the sample surveyed. An online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice. Article proofed and edited for publication by Dr. BM Janaway.
Sources and Further Reading
- Jen MH, Bottle A, Majeed A, Bell D, Aylin P. ‘Early In-Hospital Mortality following Trainee Doctors’ First Day at Work’. 2009. PLOS Journal.
Images sourced from Pixabay