The first thing I remembered was waking up in a strange room with severe pain in my lower back. It felt like someone was jabbing an ice pick into my spine, repeatedly.

Indeed, as it turned out, a man was actually standing behind me and poking me with a long metal needle. "Don't move!" he warned.

It took me a few moments to realize that I was in a hospital emergency room. The clues gradually emerged: Everyone was wearing scrubs or white coats, the room was loud and harshly lit, blood (perhaps mine?) spotted the floor, and, tellingly, I was freezing -- marginally covered with a hospital gown that didn't quite merit a 5-thread-count rating.

"She's awake," proclaimed the young nurse who also was restraining my hands. Then, turning to me, she whispered, "You're in the ER. They're doing a spinal tap on you."

In the long and difficult days that followed, I would gradually come to understand what had happened to me that night. How I'd been found in a semiconscious state and transported by ambulance to that ER. Why my left side was bruised and swollen, my street clothes strewed with leaves and dirt.

Still, despite my overwhelming confusion, I was solidly conscious of one unsettling fact: that it was early July. And that meant it was highly probable that a brand new doctor, fresh out of medical school, was the person struggling to insert a needle into my spinal column.


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Fortunately, my friend Joan -- a seasoned physician -- had been notified that I'd been taken to that ER and came to support me. She instantly registered my plight and offered assistance to the new doctor. Freely acknowledging his inexperience with the procedure, he was grateful for her guidance about repositioning the needle (into the correct location) and angling it into my spinal column (instead of my now-porous vertebrate). The spinal tap subsequently succeeded, but the new doctor's many failed attempts left me with a mind-numbing headache that precluded my ability to sit upright and lasted an entire week.

Inarguably, my care suffered the legendary "July effect" -- the purported phenomenon of medical errors spiking in July as a consequence of new doctor-trainees arriving at teaching hospitals for their clinical training.

At the same time, because the academic year both begins and ends in July, the experienced staff who have completed their training leave the hospital. This annual mass turnover involves more than 100,000 staff members in U.S. teaching hospitals and, as a consequence of the abrupt decline in their collective experience, many people believe that patient safety is jeopardized.

This so-called July effect has been both discredited and validated by various researchers. Their contrary conclusions have been difficult to reconcile because they've contextualized their research in such dissimilar ways. They've often focused on different pieces of the same puzzle, employed different concepts of what counted as medical error, or examined patient safety in critically dissimilar hospital settings.

For example, a systematic review of medical research investigating the phenomenon of the July effect was published in 2011 by the Annals of Internal Medicine. Drawing on 39 studies performed over 21 years, its authors concluded that patient mortality increased during the July changeover in hospital trainees.

In contrast, however, a study published this year in The Journal of Neurosurgery found no higher mortality rates for patients admitted in July to teaching hospitals. But it's important to note that the researchers focused solely on patients admitted for spinal surgery.

In that context, new surgeons-in-training would operate under strict observation by senior staff in tightly controlled operating-room environments, limiting occasions for error. That setting is wildly different when compared to ... say, a bustling ER to which a new medical intern has been dispatched for solo execution of an unfamiliar task involving a vulnerable patient.

In the end, despite much data and extensive research, it remains difficult to make a definitive universal claim about the July effect. Still, as spokeswoman for the Common Sense Medical Society ("Common sense in medical service of the commons") I believe the legend merits our continued attention.

Foremost, our Society proposes that questions relating physician competency to patient safety become year-round concerns, whatever the month and whatever any doctor's level of training. After all, we doctors do "practice" medicine throughout our entire careers.

We also believe it good common sense when patients inquire about their doctors' skills and experience. Knowing about them can spare you regret and headaches, literally, later on. For example, had I been alert in the ER and aware of the new doctor's inexperience, I would have requested that he be supervised before giving my consent for the spinal tap.

Finally, the Society regretfully concludes that the conundrum of the July effect will continue to prove unsolvable by traditional research methods. We simply cannot authoritatively speak about medical mistakes until we can, well, speak about medical mistakes. For that to happen, we will need to create hospital cultures in which all health care providers can safely speak up about the errors they create and witness, the experience and authority they may lack. And make no mistake about it -- that will take some time.

Kate Scannell is a Bay Area physician and the author of "Death of the Good Doctor."