On the first Wednesday in the first week of August each year thousands of newly qualified medical graduates, fresh from university lecture halls and post-graduation holidays, take up their first hospital jobs as junior doctors. It is generally thought to be the most dangerous day to become ill and has been dubbed the “killing season” or “Black Wednesday” due to the increase in patient death rates around this time.
In 2009, a study by Imperial College London involving 300,000 patients at 170 hospitals found that death rates were 6% higher on "Black Wednesday". This figure rose to 8% higher once those patients who tended to be looked after by more senior specialist doctors, such as cancer patients and surgical cases, were excluded. Recently, Sir Bruce Keogh, medical director of the Health Service, has publicly admitted that patients are at risk during this period saying “There is some evidence of increased risk to patients as new doctors take their first steps.”
Obviously it isn’t possible to limit the number of patients that a hospital is required to deal with during this period, so what can be done to protect patient safety during this so called "killing season"? A new scheme, which will become mandatory from next year, means that all junior doctors will spend a minimum of four days shadowing senior colleagues before taking up their posts. One obvious benefit of the scheme is that, because many hospitals are so vast, it can take a junior doctor a number of days to find their way around. The proposed scheme will allow them sufficient time to get their bearings without the added pressure of having to do so whilst trying to reach a patient in a critical state of health. This could mean the difference between life and death for those patients who are treated during this period.
A trial of the proposed scheme carried out in Bristol found that the number of mistakes made by junior doctors in their first four months of practice was reduced by around 50% following a period of shadowing senior colleagues. Furthermore, there was also drop in the number of patients left permanently injured or damaged following errors. The proposals have been welcomed by patients associations, who have long said that patient safety should be of paramount concern to the NHS and that the reforms are long overdue. This is little wonder as a recent survey of 51,000 junior doctors by the General Medical Council found that 1 in 7 felt that they had to deal with medical problems beyond their competence and experience, and 1 in 5 felt that they were not being properly supervised by senior colleagues.
Junior doctors are only human and it is inevitable that it will take them time to settle in to their new jobs, as it would with anyone, and mistakes are inevitable. However, with people’s lives at stake the proposed reforms appear to be an important step to improving patient safety and in turn reducing the number of clinical negligence claims. This will not only be reassuring to patients, but is also likely to have a financial benefit for the NHS if the amount of compensation that the hospitals need to pay for claims arising during this time of the year can be reduced.