The July Effect: Does It Affect Residents More Than Patients?

Always we hope
someone else has the answer.
Some other place will be better, some other time it will all
turn out.

This is it.
No one else has the answer.
No other place will be better,
and it has already turned out.

At the center of your being
you have the answer;
you know who you are
and you know what you want.

There is no need
to run outside
for better seeing.

Nor to peer from a window.

Rather abide at the center of your being;
for the more you leave it, the less you learn.

Search your heart
and see
the way to do
is to be.
Lao Tzu

It’s June 30th, the eve of the day in many academic medical centers when the new class of resident physicians take on the care of hospitalized patients. Some have said that It’s a dangerous time for patients. However, the evidence is conflicting:

Maybe this is more of a dangerous time for new doctors. We ask a lot from ourselves as interns and senior residents. As I walk in on the 5:00 p.m. brainstorming session amongst them, the senior is talking rapidly and processing how to organize the upcoming evening shift with the juniors, including a brand new first year resident. At the same time, she’s eating a light supper (talking, eating, and working at the same time) and I can see the autopilot come on. She’s fast, tough–and kind.

That autopilot is essential. It will help keep patients safe. By and large, I doubt the validity of the so-called “July Effect.” Doctors are way too conscientious, as a general rule, to let that happen.

But autopilot is how the trouble can start. Paying too much attention to all the details about what we need to do for patients would paralyze us, so we need autopilot. By the same token it can lead to a hardening of the attitudes, ignoring what we do to our bodies to last half the night on call, always doing rather than being, and making a career of being lost in thought. We can become rigid, used to being heroes for others and, by being inflexible with ourselves, become inflexible with others.

This can sometimes, for some of us, lead to burnout:

I don’t know if a mindfulness workshop over a couple of days is enough. It’s easy to get lost, go to a weekend crash course–and get lost again. I think it would take a lot more time than that for me to find my center.




  1. I’ve heard it said that November is more dangerous than July, because the PGY-1s think they know what they’re doing by then, but they don’t. I’m not sure that’s true, either, though.
    I think you do give up something of yourself to be a doctor. I console myself with the belief that you also gain something.

    Liked by 1 person

%d bloggers like this: