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The July Effect: Patient Spinal Care Service Unaffected in July

A controversial topic has been dominating headlines recently, and is an important issue that I’d like to discuss. It’s the phenomenon known as the “July Effect” – the notion that being admitted to a teaching hospital in July, the month in which medical students begin residency, will increase the risk of poor patient care and medical errors. With this uptick in concern, numerous articles have been published about the topic and rightfully disprove the claim, including research from The Journal of Neurosurgery: Spine and The Mayo Clinic. In my opinion, the July Effect is absolutely false. The Journal of Neurosurgery: Spine found that among the sicker, high-risk patients who had more illnesses and higher rates of mortality, there was no difference in any outcome of patients admitted in July compared to those admitted in another month. Jennifer S. McDonald, a researcher in the radiology department at the Mayo Clinic, made the poignant argument that “if there really was a July effect, we would expect it to manifest in these patients.”  I agree. Let’s look at spinal surgery specifically – a practice that is immensely delicate and technically demanding. At Mt. Sinai Hospital, on my service, the residents are closely supervised

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Patient Stories – Kathleen

It started about seven years ago. I had lower back pain and all of that, but I was always pretty active, so I didn’t pay much attention to it. I didn’t really think it was anything serious. When my son was home from military duty he said to me, “you know mom, you’re getting crooked.” It was two years later that I had my back X-rayed. They told me I had a curve—25 degrees at that time. I went to physical therapy and that helped for a while. It was the physical therapist who said it will either hold or it’s all going to tumble on you. It was the beginning of scoliosis—which I inherited from my dad. By the Spring of 2010 I was in agony. It was just awful. I couldn’t get straightened up. When I saw Dr. McCance he told me that I was at a 40 degree curve. Kathleen // Age: 66 Condition // Scoliosis Occupation // School Counselor (NY) How did you find Dr. McCance? I found Dr. McCance through a girlfriend who also had back surgery. She encouraged me to find him. I did see some doctors near home, but I just didn’t feel

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Patient Stories – Gregory

My doctor said I needed to get the surgery because my spinal cord might get worse by the time I’m 25. My scoliosis was 65 degrees. Gregory // Age: 25 Condition // Scoliosis Occupation // Student (NY) How did you find Dr. McCance? My doctor referred me to two doctors—one was Dr. McCance. Why did you choose Dr. McCance for your surgery? When I went into his office for the first time I saw it was very modern. I saw that the New York Daily News had an article about him. I was really impressed. At first I was really scared. The doctor made me comfortable about getting the surgery. We talked about college and girls and he made me feel comfortable. How did you feel after your surgery? The day after surgery they told me to walk. At first it really hurt. But I kept walking and the more I did it the more I got used to it. I started college one month after surgery. I walked up the stairs, walked to class, and walked up the hills. How do you feel now? I’m doing kick boxing now—it requires a lot of movement and a lot of flexibility,

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Patient Stories – Doug

In 2002, when I was in my early 50s, I had my first lumbar surgery. After that I was pain-free for 3 years or so. I had done the rehab as I was instructed and after eight months was told I could return to the gym. My original lumbar surgery was performed by a top- rated specialist at a world-class orthopedics hospital. The results were quite poor and degraded over time. They included a fusion failure at L5/S1, which I did not discover for several years. After the three years the pain returned and got worse and worse until I couldn’t walk. I couldn’t take pain pills because I had to work. By 2009 I’d had it. I saw two prospective surgeons and hadn’t made a decision. I just wasn’t sold on either of them. Doug // Age: 50+ Condition // Failed Fusion/Pseudoarthrosis Occupation // Attorney (NY) How did you find Dr. McCance? My best friend is a doctor and he recommended Dr. McCance to me. I went to see him and it was love at first sight. I was impressed with the design of his office. It was clear Dr. McCance recognized the importance of having a comfortable and

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Patient Stories – Christopher

I knew for a long time that I had a mild scoliosis in my lumbar region, but I never had any symptoms. I was active. I did a lot of weight lifting, played rugby. About nine years ago I started having a little bit of pain. It wasn’t just acute, it was also chronic. I had it every day. The first surgeon I met with said I had the back of a 60 year old and tried to blame me for my condition. He was of no help and said he couldn’t do anything. Went to another back surgeon and he thought it was too big of an area to operate. He thought steroid injections might help. And they did help temporarily. But it kept getting worse and worse. Doing physical therapy, taking steroid injections and taking all the medicines that were available—none of that was working any more. I was even getting radio frequency to block the nerve, and that wasn’t working. When I moved to New York I saw three surgeons—who took MRIs— and they all said my back was too bad—they couldn’t do anything. My whole life revolved around my back. I was always worried about not

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Patient Stories – Evangelia

I was coming home from Boston and had a car accident going 65 miles an hour. They wanted to do surgery in Boston because they said I broke my neck, but I just wanted to get home to New York. And I didn’t want to have surgery. The only thing I’ve ever had was stitches when I was twelve. And when you go online, all you see are these terrible stories and then you’re told you can die or get paralyzed, so I didn’t want to get surgery. Plus, young people like me, they don’t want surgery. When I got home the pain got terrible. It was so painful I couldn’t do anything. Evangelia // Age: 30 Condition // Broken Neck / Neck fracture Occupation // Manager (NY) How did you find Dr. McCance? I looked up a neurologist, stumbled into his office, and he ran some tests and referred me to Dr McCance. Why did you choose Dr. McCance for your spine surgery? Everyone told me to get a second opinion, that’s what you’re supposed to do, right? So I went for one and that doctor pressured me into getting surgery right away. It sounded like a hard sell

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Patient Stories – Eric

I always considered myself a young man. I was physically active. I liked to run with young guys—full court basketball—the whole nine yards. I had persistent back problems. My back would “go out” every couple of months. I just thought it was the aging process. The last time that I had it, it wouldn’t really go away. My primary care doctor knew Dr. McCance and recommended that I see him. I went to Dr. McCance and had a full set of tests. He said it was a congenital issue—the structuring of my spine. One of the lower vertebrae slipped forward and it really had to get fixed. It was a serious issue. Eric // Age: 50+ Condition // Spondylolisthesis Occupation // Lawyer (NY) Why did you choose Dr. McCance for your spine surgery? My wife is a nurse. So we did a lot of research and found out Dr. McCance is a top-notch guy. In my dealings with him I found him to be extraordinarily responsive. He’s a thoughtful guy. He provides the utmost care. I found him very personable and knowledgeable and respectful. And frank—so you feel you’re getting the right story. Another crucial element in the quality of

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Patient Stories – Denise

I had continuous pain for two years. It started in my buttock and radiated down my left leg to my foot. At first it was bearable, but after a year it became so severe that I started looking for a doctor to help me. At first I tried sports medicine doctors, and then I tried orthopedic surgeons. But I could never get a clear diagnosis. Denise // Age: 62 Condition // Scoliosis/Spinal Stenosis Occupation // Retired (Puerto Rico) Why did you choose Dr. McCance for your spine surgery? Dr. McCance was very thorough. He was clear. He’s very thorough. He was the only doctor I saw who described my back problem in very simple terms. He explained to me what would happen if I did nothing and what would happen if I had surgery. He pointed out where the problems were on my film. My pain was caused by a vertebrae that got out of alignment and was pinching a nerve. It’s so surprising that so many doctors had seen the same films, and Dr. McCance was the only doctor who really looked at it and determined what was wrong. I thought his staff was extremely professional. They were extremely

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Patient Stories – Evelyn

For me it started with a car accident. I injured my back. I did physical therapy and a lot of pain management, but I still suffered from constant pain. I am a school teacher, so it made it more difficult for me to do my job. It kept getting progressively worse. This went on for 4 or 5 years. Evelyn // Age: 44 Condition // Stenosis/Degenerative Disk Disease Occupation // Teacher (NY) How did you find Dr. McCance I went to Dr. McCance because my aunt had back surgery with him. My aunt and my cousin were raving about him. My aunt’s situation was really very severe—she was almost paralyzed. And Dr. McCance worked his magic. Why did you choose Dr. McCance for your spine surgery? I went in with a laundry list of questions and he answered every single question and more. Very patient man. Very detailed in his explanations—in layman’s terms. His staff—I can’t speak any higher about his staff—from his receptionist to his Physician Assistants. Very professional. Very courteous. I can’t speak any higher of this man. He showed me everything in detail. Showing me exactly where my problem was. Where the disks collapsed. I had to

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Patient Stories – Jim

In 1982 I injured my neck in an accident. The pain would come and go and I’d see a chiropractor once in awhile. Then, I was moving my daughter into college and I tried to move a refrigerator—and something happened. The pain was constant and so bad that I couldn’t sleep. I couldn’t even move my head. I was afraid I wouldn’t be able to drive again. I went to a neurologist who ordered an MRI. Then he referred me to a local spine surgeon. I went to see him and he explained what needed to be done. He was well-respected and everything, but I just wasn’t comfortable. And I didn’t like the idea of surgery, so I didn’t schedule anything. Jim // Age: 51 Condition // Cervical Disc Herniation/ Degenerative Disk Disease Occupation // Lawyer (NY) How did you find Dr. McCance? I was reconciling myself to a life of pain when a colleague suggested I get a second opinion from a doctor with one of the fine hospitals in Manhattan. Through my colleague’s contacts I heard about Dr McCance and then did some research on him. Why did you choose Dr. McCance for your spine surgery? When I

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