Malpractice During The Holidays

The holidays can be a wonderful time to reconnect with faith, friends and family. It can also be a dangerous time to get sick.

Something called the “weekend effect” has been studied in medicine. This describes how patients admitted to hospitals on a weekend, as opposed to weekdays, have higher rates of death and other poor outcomes.1

The Kim/PLoS One study looked at outcomes for stroke treatment in particular and concluded: “Weekend admission for … stroke was significantly associated with a higher mortality rate after adjusting for confounding factors. Further studies are required to understand factors contributing to mortality during weekend admission.”

In other words, although the reasons for higher weekend mortality need to be “studied further” it seems fairly well established that mortality (death) rates are in fact higher for the weekend admissions.

It is less studied whether specific holidays are more dangerous times to be a patient. But fromour experience, and for what we believe are many of the reasons accounting for the overall “weekend effect” we believe the answer is “yes.” Notably, the more experienced physicians (“Attendings”) tend to schedule their own vacations during the holidays, such as around Christmas, or between Christmas and New Year’s.

While hospitals are functioning during this time, the system becomes more reliant on “residents” (doctors-in-training) than at other times of the year. So, unless one thinks a doctor’s experience doesn’t improve outcomes, it would be hard not to conclude that diluting the experience of the medical team (during holidays) would not have the opposite effect.

Add to that the stresses on the healthcare system around the holidays (more alcohol and substance-related accidents, higher rates of holiday depression, etc) and most would conclude that arriving in a busy emergency room on Christmas Eve may well carry different (and higher) risks to the patient than arriving on a Tuesday afternoon during a non-holiday.

The importance of an advocate

We believe it’s always a good idea to have an “advocate” when going to a hospital –and that this may be particularly important around the holidays. Those with severe illness or in pain are generally least able to observe how they are being treated, or to do anything about it.

So, if you or a loved one require hospital care, especially during a major holiday, you would be well advised to have someone else capable go with them as an advocate.

What can an advocate do?

We would say that the first contribution of an “advocate” is to have a healthy level of awareness.

Among other things to consider, an advocate should ask whether the patient is being treated as promptly as seems reasonable, in light of their potential illness.

For example, severe chest pain or possible stroke symptoms should always be considered true emergencies, until proven otherwise. So, in either of these examples, a person should not be left sitting for a prolonged period “waiting for evaluation” or after an initial test “waiting for further tests.” This should be considered a dangerous situation, and warrant someone speaking up politely but firmly to ask for evaluation as soon as possible.

In addition to speed, the level of provider experience, relative to the problem, should also be considered. If your loved one has been seen by a very young “resident” (doctor in training) who seems uncertain of their surroundings, or can’t answer reasonable questions, then runs off and is not seen again, you may need to question whether their evaluation has been sufficient. Or
you may need to ask them (politely) in follow up if they’ve discussed their findings with a specialist or Attending.

Similarly backups in hospital systems can occur more frequently during weekends (or holidays) such as ability to get prompt Radiology studies or have an operating room available.

It’s not easy to be an “advocate” for yourself, or others. And, there are limits to what any patient (or advocate) can do to improve the level of care. But we consider that it’s healthy for any patient, especially around the holidays, to be aware of the potential “holiday effect.” Speaking up in a polite but serious way is sometimes necessary. In our opinion, it can make a real difference in the outcome of a medical event.

–Laurence M. Deutsch (12/6/23)

  1. “Patients admitted on weekends have higher in-hospital mortality than those admitted on weekdays: Analysis of national inpatient sample” Manadan et al, Am. J of Medicine Open, June 2023. See also, “Weekend effect on 30-day mortality for ischemic and hemorrhagic stroke analyzed using severity indexand staffing level”. Kim et al, PLoS One, (June 22, 2023).