Sanguine about medicine

Prof. Dina Ben Yehuda, head of hematology at Hadassah University Medical Center and recently named the new dean of the Hebrew University Medical Faculty, gives a rare interview.

By JUDY SIEGEL-ITZKOVICH
Prof. Dina Ben Yehuda (photo credit: JUDY SIEGEL-ITZKOVICH)
Prof. Dina Ben Yehuda
(photo credit: JUDY SIEGEL-ITZKOVICH)
It was the tragic death from cancer of her seven-year-old brother Zvika when she was only three years old that persuaded Prof. Dina Ben Yehuda that she wanted to study medicine.
Sixty-one years later, the longtime chairman of the hematology department at Hadassah University Medical Center and the new head of the Hebrew University Medical Faculty recalled that as a child in Haifa, she didn’t know what kind of malignancy felled her brother.
“I always wanted to be a doctor. I came to Ben-Gurion University’s Health Sciences Faculty for an interview to be admitted to the medical school and said my motivation was to find a cure for cancer. They laughed at me, but I was accepted and received my MD,” Ben Yehuda told The Jerusalem Post in an interview in her new office. She had wanted to be a surgeon, an unusual specialty for women doctors then.
Only after the late Hadassah hematologist Prof. Eliezer Rachmilevich invited her to study in the department and she fell in love with the specialty did she learn from a paper archive that Zvika had died of lymphoma, cancer of the lymphocytes in the blood.
“When I got into hematology, I felt I had come home. Today I am developing a drug [for blood cancer]. We found a protein, but the coating is not yet patented, so I can’t talk about it,” she revealed.
She recalled research carried out decades ago that found many medical students decided to be physicians because members of their families contracted serious diseases.
“My mother was a Holocaust survivor, and my father came from Poland before the Nazis came to power. They never talked to me or my elder sister about the Holocaust or about Zvika.”
Hematology, which involves a wide range of blood diseases – benign and cancerous, inherited and acquired, fatal and curable – is not a calming place to work. Doctors and nurses get attached to their patients, who may be hospitalized for weeks or much longer.
They become like family. Many recover, but even more die. A medical staffer must be tough to observe these frustrating cases – and Ben Yehuda is tough.
During the Yom Kippur War, she coordinated the treatment of casualties for members of the Armored Corps and their families and was awarded the Chief of Staff’s Medal in 1967.
She completed her internship in internal medicine and hematology at Hadassah and her post-graduate research at the Center for Cancer Research at Memorial Sloan-Kettering Hospital in New York City.
BEN YEHUDA, who took up her new job last October, is the second woman ever to head an Israeli medical faculty after Prof.
Rivka Carmi – who is president of BGU – was named dean of BGU’s Faculty of Health Sciences in 2000. The Hadassah hematologist is nevertheless a pioneer, having become the first woman to head the HU Medical Faculty when she was named its 23rd dean since it was established in 1949.
The Hebrew University and the Hadassah University Medical Center, which are partners in the faculty, rotate the dean position.
She succeeded Prof. David Lichtstein, a HU physiologist who held the position for four years.
The faculty includes not only the Medical School but also the School of Pharmacy; the Nursing School; the Braun School of Public Health and Community Medicine; the School of Occupational Therapy; the Tzameret Military Medicine Program; the Institute for Medical Research Israel-Canada; and the Medicine and Biomedical Research Program, designed for those who hold a bachelor of science degree; and trains medical students in biomedical research at the graduate degree level. The Dental Faculty is separate from the Medical Faculty.
“Our faculty is unique in that it trains a wide variety of medical professionals: researchers, pharmacists, specialists in public health, occupational therapists and nurses,” Ben-Yehuda said. “There must be interconnectivity. Only with the cooperation of all sectors, including students, can we train the next generation of medical professionals and give them the ability to understand the nature of the profession, while striving for knowledge, professionalism and respectful and ethical behavior in the process.”
Asked about the fact that 50% of HU medical students are women, Ben Yehuda does not respond when asked if females have more compassion than males or different in any other way. It may be that some choose specialties that are less demanding because they usually have children to raise.”
Her vision is to train doctors “who know the basic science and also understand that at a time of big data, sophisticated scanners and artificial intelligence, there is no substitute for talking to the patient, examining him and touching him. I have an examining table in my hospital office with a curtain.
So many times, I walk with the patient behind the curtain and he says the most important things there, things they don’t want their wife or parent or child to hear.
There is no replacement for putting your hand on the patient’s stomach and finding out when he feels pain.”
Upon her return from New York to Israel in 1992, Ben-Yehuda established a lab for the diagnosis and research of malignant hematological diseases. A decade ago, she was appointed professor at the medical faculty and since 2002 has been running the hospital’s hematology department. She is involved in innovative research in the treatment of malignant cells using nanoparticles of a protein inhibitor in combination with extensive clinical work.
The new dean is the mother of three girls and is married to Prof. Arie Ben Yehuda, a geriatrician and head of Hadassah’s internal medicine department, so they are both very busy.
One of their daughters, Shira, has just finished her internship at Hadassah. Another daughter, Or, made headlines in 2014 when, as a company commander in the Caracal Battalion, she went to the scene after spotting suspicious figures on the Egyptian side of the border, close to the security fence.
Smugglers opened fire at her from three different locations, and two other soldiers were wounded from crossfire from a drug smuggling attempt that went wrong.
Or returned fire despite incoming gunfire and being wounded; she was taken in moderate condition to Soroka, where she was successfully treated. Their third daughter, Bavat, is an academically trained musician.
THE NEW dean says she continues to see hematology patients at Hadassah between 6:30 and 8:30 a.m. every weekday. “I also spend one day a week in the clinic. I am still head of hematology. I had to be persuaded to run for the deanship. I didn’t become dean to do administration; the faculty runs itself. I came to set the way for the next generation of physicians. I want more physicians who are MDs to add Ph.Ds and treat patients while doing research.”
Medicine is very different today than when Ben Yehuda did her internship at Hadassah.
“Medical technology has changed face of medicine. Most of the diseases are the same. When I give my opening lecture to students, I show a skull from 4,500 years ago; the person suffered from multiple myeloma. Then I bring a contemporary one. They look the same. But doctors are not the same. The amount of data is huge.
Patients go into Google and print out so much information that they seem as if they are providing a second opinion! “In the old patriarchal medicine system, the physician used to say: ‘Don’t worry. I know exactly what to do and how.’ It was easier. Today, people read about their disease, but they feel they have lost control when diagnosed. They yearn for routine. It isn’t good if you read too much on Google.
Information is like medication. It should be delivered by the right person and in the right amount. Not everybody can diagnose and prescribe,” said the veteran hematologist.
“I sit with the patient and tell him about his disease. It often happens that I hear him call his wife, and he tells her many things I didn’t say. The patient asks me his chances for survival; I don’t like to put it into numbers, but when he insists, he remembers every number and percentage I tell him.
Numbers speak for us; they are part of our everyday life. I tell him that if he’s cured, he is 100% for me.”
Disease statistics, she continues, “help doctors make medical decisions. If 100 patients got a bone-marrow transplant and 100 didn’t, and those who got it recovered, I will do it. But it’s not desirable to give patients percentages.” She herself learned how to give patients bad news, “and we teach it today, but we have to do it better.
Although the existing medical school administrations around the country voiced opposition when plans were announced for Bar-Ilan University to open a new medical school in Safed, Ben Yehuda says she has no objection to new schools, just as she does not oppose Ariel University in its plan to open a medical school in Judea and Samaria.
“They are welcome. There are many Israelis who go abroad to study medicine because there are so few spots here and do fine; this would be discouraged. The main problem with new medical schools is that there are not enough professors and beds in Israeli hospitals to provide students with clinical teaching.”
Although the Internet supplies medical students and doctors with instant information, they must still learn things by heart, insisted Ben Yehuda. “Suppose they’re in a hospital emergency room and something happens that cuts all online access. How are they to treat patients? I see so many patients in a day. You sit opposite him or her and hear their problems. You can’t go to the Internet to solve them. You have to know. Today’s students may say they don’t want to memorize so much, but they have to learn at home and in the classroom and understand. We are working hard to change the curriculum to integrate both data mining and understanding. My husband headed a committee that changed the syllabus to a curriculum of systems, about the healthy person the sick person, morphology [structure] and physiology, pharmacology, the individual and bodily systems.”
AS TREATING acute diseases, such as infections, takes up less of the volume of medical care, doctors will have to focus much of their time on chronic illness in an aging population, she continued. Patients prefer to be treated in community facilities than to lie in hospitals, where there still a risk of nosocomial (in-house) infections.
“We are stressing community medicine, even though it could come at the expense of hospitals that have to balance their budget.
Just last week, I gave a single patient a lifesaving drug that cost NIS 130,000.”
Having served three times on the health basket committee for deciding what new medical technologies will be provided by the four public health funds, Ben Yehuda said the Israeli basket “is the best in the world. I try to persuade patients to switch to generic drugs rather than the much-more-expensive brand names if they have been carefully checked. This will help us make room for newer medications. I have sat in many committees and I was never so proud as when I was in the basket committee.” Prof. Jonathan Halevy, the director-general of Hadassah’s competing Shaare Zedek Medical Center, was committee chairman each time, and “he did an excellent job,” she declared.
Ben Yehuda, who doesn’t much like the press and is usually reluctant to give interviews, declined to answer a number of touchy questions, such as about criticism that the school of public health is reluctant, as an institution, to be activist and vocal on controversial public issues.
Another was about last year’s battle over Hadassah’s pediatric hemato-oncology department, Hadassah Medical Organization director-general Prof. Zeev Rothstein and eight oncologists’ leaving Hadassah in a failed effort to start a new department at Shaare Zedek. All she would say is that “Prof. Rothstein came here to save Hadassah, and he is doing very good work.”
She feels that “the media in general have been unfair to Hadassah. Instead of throwing mud, they should write about positive things. It’s better for them not to write about us at all. Hadassah has some of the most devoted doctors and best scientists I have ever met.”
Asked to comment on his former basket- committee member, whom he knows well, Halevy – who has run Jerusalem’s competing medical center for over three decades, told the Post: “Dina is one of the most devoted and talented physicians I have ever met. It is true that she is very loyal to Hadassah, which is her alma mater after graduating from BGU’s medical school. Yes, she can be tough, but she is never tough with her patients.”