A recent column by Dr. Pauline Chen at the New York Times explores a surprising oversight in modern healthcare: Doctors don’t really have a clue how to predict how long a patient will live. In the absence of a widely accepted, systematic method of prognosis, they’re kind of making it up—an informed guess, with the benefit of education and experience, but a guess nonetheless.
Prognosis was once a diligently studied, widely practiced part of a physician’s job, Chen writes. But as treatments improved, and keeping patients alive longer became ever more possible, the unpleasant but necessary skill of predicting when patients might die fell by the wayside. A recent study, she reports, revealed just how much:
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“Killing season,” a term used to describe the time when junior doctors take over at hospitals, was thought to be just an unsettling joke. However, British researchers found hospital mortality rates rise by 6 per cent on the first Wednesday in August. Perhaps not coincidentally, that is also the day newly qualified doctors, fresh from medical school, are let loose on the wards of [England's National Health Service] hospitals [Daily Mail]. There could be lots of explanations for the increase, so the authors say their data doesn’t mean people should shy away from hospitals during this week, but they do say the increase is statistically significant. The report was published recently in the journal PLoS ONE.
To arrive at their result, an Imperial College team looked at 300,000 emergency patients admitted to English hospitals between 2000 to 2008. They compared death rates between the first week of August, when new doctors arrive, and the previous week in July [BBC News]. The study’s authors note that past studies looking at mortality rates before and after junior doctors take over did not find any difference. The results could be due to the different types of patients being admitted, but if it turns out to that there is some merit to the “killing season” myth, it could have large implications for how young doctors are turned loose.
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Image: flickr / [lauren nelson]
