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Rate of undesirable events at beginning of academic year: retrospective cohort study

BMJ 2009; 339 doi: (Published 14 October 2009) Cite this as: BMJ 2009;339:b3974

Simple solutions to August problem

The study by Haller et al (BMJ October 2009) finally provides some
data to support what all doctors already know – August is no time to get
sick in the NHS. Certainly trainees rotate at other times of the year on
three, four and six month placements but August is when all the brand new
Foundation doctors begin and most hospital doctors move to new posts. I
have found myself apologising for this ridiculous phenomenon more times
than I can remember and would have grave concerns about any member of my
own family going into hospital in August.

The authors offer some solutions which predominantly affect practical
specialities such as Anaesthetics but have missed two relatively simple
ones which would, I believe, dramatically improve patients' experiences.
The first undeniably less popular option would be to suspend all annual
leave in August.

Currently almost every Consultant and many senior doctors take their
longest annual holiday in August and trainees very often start their first
ever job without a senior member of the team available to supervise them.
Doctors themselves are only too aware of the absurdity of this situation
but what are they to do when their juniors start work right in the middle
of school holidays? The absence of a senior places huge pressure on F2
doctors who may themselves be relatively inexperienced, and leave them
little opportunity to supervise the new F1’s. Suspending all leave in
August may seem drastic and would be unpopular but would significantly
improve support for juniors and protect patients.

Alternatively, why not move the starting month for new doctors to
September as has been suggested countless times before? This strikes me as
a relatively straightforward way of virtually eradicating the August
problem. Trainees will still be inexperienced when they start work, and
this could certainly be addressed using focused skills-based training, but
there is no substitute for close supervision by experienced doctors in the
first few weeks.

Competing interests:
None declared

Competing interests: No competing interests

26 October 2009
Liz Tate
ST3 Psychiatry
Wessex Deanery