Of course, there's never a great time to get seriously ill. If you work in the NHS, however, chances are that your experiences will have particularly prejudiced you against August. Charmingly known as the "killing season", this is the month when junior doctors start their first posts after graduation. The anecdotes are ripe and scary: junior doctors getting entirely lost on their way to a cardiac arrest call; mistakenly writing up quantities of drugs more suitable for horses; being harassed by nurses and ending up in tears in the toilet; or simply forgetting about patients on distant wards altogether.
Luckily there's not a drop of truth in this. The mortality figures stay even over the summer, despite the new intake of fresh medical blood. A study in the British Medical Journal more than a decade ago compared the death rates of July, when junior doctors would have been at their most experienced, with those of August, when they would have been starting out, and concluded that the "killing season" was but medical myth.
The past decade has seen big changes in the way junior doctors work and the way hospitals are staffed out of routine hours. It used to be that small teams worked nights-on-call and then the next full day: early in the morning, intravenous drugs were made up while wiping sleep and dried-up mascara from exhausted eyes. Medical errors are rather more likely if you haven't slept for two days.
The European working time directive has gradually brought down the amount of hours worked by doctors. This hasn't been universally popular - some trainees are appalled at the reduction in training they will have before being appointed consultants and Trusts are heavily fined if they don't comply with the directive - but it's probably made hospitals safer for patients. In general practice, many have been delighted to drop the obligatory out-of-hours commitment. Save for a few early mornings on call, I now begin the week slightly more fresh-faced than my weekends splintered with work left me.
Still, it does seem that when it comes to getting ill, some times are better than others. A Canadian study, published in the New England Journal of Medicine in 2001, found that certain serious conditions had higher death rates at the weekend compared with weekdays. They compared these conditions with other serious illnesses, such as heart attacks, which showed no difference between weekdays and weekends and found that, while the latter were treated in specialised cardiac units, for example, and, significantly, with a more constant number of shift-working staff, patients with the former simply had a lower number of staff looking after them.
In the UK, Dr. Foster, an independent health research organisation, has recently produced figures that broadly concur with this, suggesting that death rates in hospital rise over the weekend. In some ways this might seem logical - for example, increased use of alcohol at the weekends leading to accidents, a smaller proportion of patients being admitted routinely for less complicated, planned tests - but the death rates were adjusted to take these factors into account, and they concluded that the level of staffing, rather than these other variables, was the most likely to make an impact on death rates.
If this is true, shouldn't we be reorganising staffing levels? It would make sense to have the same levels of staffing for emergency cases whenever they occur - doctors, nurses, porters, technicians and phlebotomists. However, if this meant that staff were simply spread more thinly a higher number of night staff may not lead to better outcomes. And, of course, more staff working unsocial hours costs money.
All this could be solved if we could accurately predict the amount of emergency or urgent cases that would require attention. But is it possible?
Interestingly, there are patterns about what types of admissions happen when: in Russia deaths from violence, alcohol poisoning, accidents and heart attacks occur more frequently from Saturday to Monday. In Scotland, there is an increase in deaths from heart attacks occurring outside of hospitals on Mondays (the research paper, at least proving a partial sense of humour among epidemiologists, was entitled "I don't like Mondays").
My instinct is that winter Monday mornings are the busiest of all, but the Met Office is rather more scientific. The weather, it seems, can be used as a predictive tool. It says there is evidence to link mortality and a fall in temperature - with a lag from two days (heart attacks) to 12 days (respiratory infections). In previous pilot studies, it has managed to predict decreases in hospital admissions, allowing efficient rescheduling of surgical beds.
So if predicting the busiest times of the week and year is possible, can we employ some staff only on Mondays and over winter? If it means that I get the rest of the week and the whole summer off, I might actually consider it.
Margaret McCartney is a GP in Glasgow.
