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Wednesday, October 21, 2009

Contrasts

If you ask pretty much any Olim (immigrants to Israel) how their 'klita' (absorption into Israeli society) is going, they are likely to share a host of horror stories about their encounters with the various bureaucracies here as well as the slow process of cultural acclimatization to the abrupt way native Israelis tend to interact.

However, after they've had their chance to vent, there will usually emerge at least an equal number of heartwarming 'only in Israel' stories that help balance the scales. 

You may remember that my parents are relatively new Olim.  They spend part of each year in the US, but spend the majority of their time here.

During their last visit to the US my mom had on operation on her hand.  The procedure was performed by one of the top hand surgeons at New York's Hospital for Special Surgery, and from all reports the operation was a great success.

However, in the post-operative stage of things it quickly became apparent that the surgeon and patient would have only as much contact as would be absolutely necessary for the hand to be perfunctorily examined... and that no words - especially no questions - would actually be allowed to pass directly between patient and doctor. 

Instead, there would be several layers of secretaries, physician's assistants and nurses to insulate the surgeon from anything more than the most clinical contact with his handiwork.  Just as the immediate area of the incision had been carefully draped in the operating room to exclude all other parts of the patient from view... my mom's surgeon continued to relate to her as though she were still asleep on the table with all but her knuckles carefully draped.

Having been born and raised in the US, both of my parents were used to a certain, shall we say, professional aloofness on the part of physicians... especially those at the top of already rarefied disciplines.  But even so, they were a bit put off by the fact that the surgeon who had, without question, performed stellar work was unwilling to pass even a moment's discussion with the owner of the hand he'd repaired.  After every attempt at contact, he simply waved them away and assured them that his staff would be able to answer any questions.

Fast forward a couple of months and my parents found themselves back in Israel. 

Zahava did a lot of leg-work before they returned to make sure we had the names and numbers of hand therapists and physicians who would be able to follow up with my mom's post-operative care.  But even with this significant groundwork taken care of, it still took a few weeks before my mom had a regular schedule of sessions with an occupational therapist (not a physical therapist)... and an appointment to see an Israeli hand surgeon who could monitor the post operative care.

It actually took a little time to wrangle the appointment with the hand surgeon since my parents had decided to get a consultation from one of the top experts in the country; one of only a couple who actually perform this particular procedure.   So on the day when my mom's 5:00 PM appointment rolled around, my parents were careful to leave two hours early in order to make sure they were on time.

Unfortunately, the best laid plans and all that... delays on the bus and a missed connection turned what should have been an hour ride into more than two-and-a-half hours. 

As you can imagine, my parents were beside themselves with worry as the time for the appointment neared and they were still on the bus.  My dad made several frantic calls to the doctor's office to assure them that they were on the way and not to leave.  In each case the secretary gently assured them that it was all right... whenever they arrived would be fine.

When they finally walked into the office it was after 5:30.  But to their surprise, the waiting room (or more correctly, waiting corridor) was still full of people.  When my mom tried to go in, the secretary said that she still had plenty of time and to take a seat.

Apparently, unlike their experience in the US, my parents noticed that things were severely backed up because the doctor personally took a lot of time with each patient (i.e. as much as needed).  It turned out that my mom was the last patient to be seen, and it was well after 8:00 PM before she walked in and sat down next to the doctor. 

The surgeon took her time with my parents, examining the repaired hand, evaluating the other arthritic hand for a potential future surgery, talking about the therapy sessions and the progress being made, and of course carefully answering each of their questions.  Near the end of the interview the surgeon told my mom that she wanted another x-ray done and wrote out a referral.  However, as it had been such a long day and my parents were so tired and hungry, they decided not to go directly for the x-ray and opted to go home and deal with the radiology department the next day.

As they stood at the bus stop anticipating another extended journey home, a woman came running towards them from the direction of the building where they had just been.  It was the hand surgeon.  She apologized for how long they'd had to wait and told them it had been her intention to offer them a ride home once they'd finished getting the x-rays.  When they hadn't shown up right away, she assumed (correctly) that they had decided to deal with the x-rays the following day.

My parents gratefully accepted the offered ride and went with the doctor to her car which was parked nearby.  But once they were in the car and most of the way home, my parents got a bit of a shock when they asked the surgeon where she lived.  They had assumed she lived in their neighborhood and had offered the ride after seeing their address in the computer.  But to their surprise the doctor explained that she lived in the same area as her office, but felt so bad about how long it must have taken them to get to her office and how they'd waited so long to see her, that she felt compelled to drive them home.

I would have chalked this up to a remarkably kind individual and nothing more, except for another positive experience my parents had with the Israeli health-care system:

A couple of years ago my father had suffered what we think must have been a mini-stroke.  During a walk through Jerusalem he suddenly felt dizzy, and lost some sight in one eye.  Fortunately within a relatively short time he was examined by a doctor and had a battery of tests done and eventually was given a clean bill of health. There was some lingering doubt about what had actually happened to him, but the docs decided it was best to treat him as though he'd suffered a small stroke.

Fast forward a week to when my dad went with all his test results for a consultation with a doctor who was not only considered one of the leading neurologists in the country, but she also specialized in the geriatric end of that field. 

While going through my dad's test results and asking him a long list of questions about his past and present health, the doctor suddenly stopped and began looking closely at one of his cheeks.  Without missing a beat, she told my dad that she had noticed a small skin tag on his cheek which she didn't like the look of, and she wanted him to go across the hall to a dermatologist colleague of hers to have it cut off and biopsied.

It turned out the skin tab was just that... and nothing to have been worried about.  But in looking back my parents were amazed by what had happened.  Here was a highly recognized physician... at the very top of an already very specialized field... and in the midst of going over complex neurological test results she was able to maintain such holistic view of my father as a human being that she noticed a potentially worrisome skin problem and wanted have it checked right away. 

In discussing it later, both of my parents agreed that in all of their experiences with medical specialists in the US, they couldn't imagine one of them stepping back and adjusting their focus to encompass the entire human being sitting before them. 

I'm sharing these stories here, not to imply that doctors in the US are arrogant jerks or that Israeli doctors all have hearts of gold.  Obviously there are many examples of both (and everything in between) no matter where you might look.

But if I were to dabble in sweeping generalities (always a dangerous game), I'd have to say that aside from old-time general practitioners and pediatricians, the physical, clinical and social distance that exists between doctor and patient in the US, is much larger than what you are likely to experience here in Israel.  And Israeli doctors seem to be more accustomed to treating humans rather than the assorted parts of which we humans are composed.

I like that.

Posted by David Bogner on October 21, 2009 | Permalink

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I doth protest to the generalization.

Posted by: dave | Oct 21, 2009 4:15:38 PM

Dave... I think we can both agree that you fall completely under the category 'old-time general practitioners'. :-) Seriously, you have to admit that in a larger practice or a denser patient population, you wouldn't be able to deliver the standard of care (including the personal touch you always gave me and my family) that you do. Let's face it, you are a small town GP and damned good at what you do.

Posted by: treppenwitz | Oct 21, 2009 4:32:05 PM

Zehava did leg work for a hand? Excellent. :-)

Posted by: Marsha in Englewood | Oct 21, 2009 5:27:33 PM

David

I've had seven surgeries (six major ones) over the past 20 years with 5 different surgeons (each one among the top in the field). Some of them have been total menches and some have treated me similarly to what you describe (although not quite so bad).

While none have driven me home, one agreed to take my insurance (even though he doesn't normally take insurance) and one, the most recent one, worked with me in a very fair way on the financial front.

So, it is very hard to generalize.

Posted by: moC | Oct 21, 2009 5:37:32 PM

How come the doctor that a Jewish person goes to is always the top in his field?

Posted by: Ber | Oct 21, 2009 5:55:28 PM

Whoa. I have to say that if we are indeed engaging in the dangerous games of sweeping generalities that this has not been my overall experience of the health care system here in Israel. I find the doctors to be competent, the care to be convenient and cheap, but the bedside manner to be coarse and dismissive, as compared to the doctors I saw in the states. Now that is of course generally speaking. Our pediatrician is a gem and the doctor at Hadassah Ein Kerem who does the follow-up for the illness my daughter had before we came is also amazing.

So, no, I don't think you can engage in sweeping generalities. I think every doctor has to stand on his own. Some are good doctors, others are not. Some are people-people, others are not. And this goes both for the US and Israel.

Posted by: Baila | Oct 21, 2009 5:56:13 PM

It's tough to be general. I have 2 Drs. here in NYC that take his their time seeing me and another one who is literally in and out because its a conveyor belt in his office. I'm glad your folks got special care. Always nice to hear their are medical professionals that at real menches (and menchettes)

Posted by: J K | Oct 21, 2009 7:33:33 PM

Trep - you write with such talent, able to turn a simple matter into an experience for us all to share. thank you for sharing this heartwarming story. may your family and your parents be well and live a long a happy life.

Posted by: Hadassah | Oct 21, 2009 7:50:38 PM

My experience of Israeli hospitals is restricted to one, the Wolfson in Holon. I found the staff there totally incredible. They are all run ragged, they are so busy, but put a patient in front of them, and it is as if the mayhem around them vanishes, and the patient becomes the most important person on the planet. I know they are terribly underpaid for the hours they work - no one goes into medicine in Israel for the money or the working conditions:-) I am happy to hear your parents got really good treatment in their new home. It is so important, especially as our parents get older, to know that they will get the best care available, and not be fobbed off just because they have silver hair.

Posted by: Noa | Oct 21, 2009 8:14:17 PM

Stop comparing countries... and generalizing... Good and bad people are everywhere.

But we all love nice happy stories where people treat each other nicely, so thanks for sharing.

Posted by: val | Oct 21, 2009 8:44:55 PM

A French TV program (a Jewish one of course) has featured wonderful documentaries about Israeli doctors. If I had to go to hospital or the doctor's I guess I'd rather have to do it in Israel than in the US.

Posted by: Ilana-Davita | Oct 21, 2009 9:24:27 PM

My mother fell down a flight of stairs last week and broke multiple bones.
She was seen here in the States at a local hospital where she received magnificent care that was professional, caring, timely, and appropriate. Any study that she needed, including multiple CT scans MRI's and vascular studies were done in less than 12 hours. She was seen by specialists in 5 different fields who were all great. Her follow up care has been terrific as well.
While I believe her experience was terrific, I don't think it reflects on all doctors everywhere.
It probably doesn't pay to compare apples and oranges.

Posted by: Larry Stiefel | Oct 21, 2009 11:24:29 PM

im with baila. i find israeli doctors to be brusque, sometimes to the point of being callous about your pain.
but of course you cant generalize, im just speaking about my overall experience.

Posted by: fred | Oct 22, 2009 1:44:16 AM

This wasn't obviously the point of your post but I immediately noticed that you refered to both doctors who are at the top of their fields in Israel with "she" and not "he" (as I expected)

Pretty darn cool.

Posted by: Naomi | Oct 22, 2009 10:01:12 AM

Ber

I don't know about all Jews using the top doctors in their fields but in my case it's because I used to have great insurance that paid for the top doctors. (And, Jews somehow know how to identify the top doctors). Now, of course, most top doctors (especially surgeons) don't take insurance at all. So, in order to get a top surgeon this time I had to go out of pocket quite a bit because my insurance whacks me big time if I go out of network.

Posted by: moC | Oct 22, 2009 5:47:39 PM

Kleenex alert! (Maybe I'm just overemotional ;))
I love it.

Posted by: SaraK | Oct 22, 2009 9:00:49 PM

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