About 20 years ago, the deputy head of cardiology at an Israeli hospital invited
me for an interview about the latest developments in his field. Entering his
office, I detected the odor of stale tobacco smoke.
“Could it be that
you, a leading cardiologist, smoke?” I asked in disbelief. He blanched and
pulled open the top drawer of his desk, revealing dozens of packets and dirty
“Please,” he entreated. “Don’t write about it in the
The heart specialist is no longer with us, and in general there
are many fewer doctors today who light up than there used to be. But one can
still see some MDs huddling outdoors with a cigarette during breaks in medical
conference sessions who don’t practice what they should be preaching to their
Physicians get sick, suffer from chronic physical and mental
illnesses and eventually die, like their patients do. But too many tell
themselves: “It won’t happen to me.” As a result, most of them – according to a
prominent family medicine specialist – don’t have a general practitioner or
family physician, even though all of them are members of a health fund under the
universal National Health Insurance Law.
“Most doctors don’t have their
own doctor,” asserts Dr. Amnon Lahad, head of family medicine at at the Hebrew
University- Hadassah Medical School and at Clalit Health Services’ Jerusalem
“Instead, when they get sick they treat themselves, or, if it’s
more serious, they consult with a colleague in a hospital or clinic corridor.
Usually, neither of them has the time to sit down together for a consultation.
The doctor who is a patient tends to find it difficult to fit an appointment
into his [or her] schedule,” says Lahad, who has studied the issue.
issue of medical care for physicians was most recently raised in Harefuah, the
Hebrew-language journal of the Israel Medical Association. “Who will doctor the
doctor? Recommendations for doctors on a healthy way of life” was written by
Safra Children’s Hospital sports medicine expert Dr. Gal Dubnov-Raz; metabolism
and nutrition Prof. Elliot Berry of Hadassah’s Braun School for Public Health
and Community Medicine; Hadassah Optimal sports medicine director Dr. Naama
Constantini; and Dr. Ofer Shemer of Tel Aviv University’s Sackler Medical
“Observing a healthy lifestyle is mandatory for the whole
population – the healthy and the sick, young and old, doctors and patients. We
are liable to think that we [doctors] are protected from those same diseases and
conditions that [we see in] our patients all the time. Doctors,” they write,
“tend to go to work when they are ill and to ignore mild symptoms through
avoidance and the belief that their medical knowhow will protect
But doctors are exposed to dangers connected with their
profession, the authors continue. These include sedentary habits from using the
elevator and a computer for hours on end, weight problems due to poor eating
habits, hypertension, depression and addiction to tobacco, alcohol and even hard
Physicians also have the tools to transmit health messages to
their patients, the medical journal article writers continue.
can serve as a personal example in his behavior and way of life, give positive
examples from his personal experience in improving nutrition or increasing
physical activity, encourage the patient and supply the mental fortitude he
needs to improve his habits.
“The doctor can also create in his clinic an
atmosphere of health promotion with leaflets, pictures and posters and even
integrate the clinic team in existing groups of exercise, programs to improve
lifestyles, healthy cooking workshops and so on.”
While there is little
data on the health of Israeli doctors, other countries do more research. There
are numerous published studies in the US on the subject. Journal articles show
that a third to a half of physicians polled admit to being
The Australian Medical Association (AMA) has devoted
considerable attention to the study of doctors’ health. Just last April, the AMA
issued a “Position Statement on the Health and Wellbeing of Doctors and Medical
“Research shows that doctors with healthy personal lifestyle
habits are more likely to impart healthy behaviors to their patients,” it
stated. “As a profession, it is important that doctors look after their own
health and the health of their colleagues.
Many doctors can become so
focused on their practices and the health of their patients that they neglect
their own health and wellbeing. It is difficult for doctors to properly look
after their patients if they are not staying healthy and well themselves. Junior
doctors may experience pressures and stress throughout their training due to
long hours and irregular shifts. Experienced doctors confront barriers to their
own good health throughout their careers.
“The AMA recommends that all
doctors should have their own general practitioner rather than attempting to
diagnose and treat themselves. Doctors and medical students should make better
life choices to maintain their good health. They should take regular leave,
enjoy good nutrition, undertake regular exercise and pursue a balanced lifestyle
between work, family and leisure. They should also keep on eye on the health of
their fellow doctors. Doctors have legal and ethical responsibilities to respond
to when they become aware of a colleague who is having health
Israel’s Health Ministry has not issued such a clear
statement, nor do the Harefuah authors mention in their survey whether the
Israel Medical Association has.
The Lancet medical journal in Britain
looked some years ago at the possible link between poor doctor health and poor
patient care via an objective review written by experts from University of
Calgary in Canada. It showed that doctors’ stress, fatigue, burnout, depression
or general psychological distress are common and negatively affect healthcare
systems and patient care. The researchers proposed that “because wellness may
not only benefit the individual doctor but also be vital to the delivery of
quality health care, physician wellness should be included as an indicator of
Ultimately,” they continued, “individual doctors
will personally benefit from taking better care of themselves. Such efforts
would probably lead to increased job satisfaction and overall wellbeing... The
organizations employing doctors will benefit by having more productive and
efficient healthcare providers in conjunction with reduced absenteeism, job
turnover, and recruitment and retention issues. And perhaps the patients
themselves will benefit by receiving better quality of care.”
could not quote comprehensive surveys of Israeli doctors, they mention that
Clalit Health Services issued a study of its medical staffers showing they were
just as likely as the general population to undergo screening tests for breast
or colon cancer or high blood cholesterol.
However, they were less likely
to test their blood pressure and had a significantly lower smoking rate than the
public at large. Like ordinary Israelis, many of the doctors polled complained
that lack of time, motivation and facilities made it difficult for them to
exercise. The authors conclude by urging doctors to take the stairs rather than
the elevator, substitute vegetables and fruits for junk food and make other
steps to improve their health.
Lahad says that a year ago, the Israel
National Council for Community Health recommended a system to improve
physicians’ health, giving most stress to their psychological health. But it is
a rare physician who is willing to pour his heart out to a staff psychologist or
psychiatrist about his emotional or mental problems – either out of
embarrassment or fear that it could, if known to management, lead to
“It’s a profession with heavy pressure, long hours and lots of
burnout. Nobody knows how many doctors here suffer from depression, as there are
no surveys, but we all have anecdotal evidence.”
Lahad continues: “It is
too easy for a doctor to self-treat. We are free to write our own prescriptions
and go for any tests we wish. There are those who go for an excessive number of
tests, while others undergo too few; it seems as if younger physicians tend to
go for more tests than older ones. I have a health fund doctor who gives me
prescriptions. For renewing prescriptions, to save time I write them out myself,
but not the first time,” says the Clalit family physician.
take measures to promote their own good health “are better health educators of
their patients. If they exercise, studies have shown, they tend more to
recommend exercise to their patients. If they don’t get a flu shot or if they
smoke, they are less likely to talk to patients about smoking cessation or
vaccination, so their patients’ health can suffer,” Lahad says.
Djemal, medical director of TEREM’s Family Care Clinic in Jerusalem and a
veteran family physician who recently received an Outstanding Physician award
from the Israel Association of Medicine and Law in Israel, says that “in
general, doctors aren’t good at taking care of themselves. They have an
irrational belief that people who take care of the health of others somehow have
immunity from serious disease.”
The very fit Djemal tries to practice
what she preaches to her patients and medical staff. She jogs in the early
morning in the Katamon neighborhood before going to work and is thrilled when
seeing some of her patients doing the same.
“I believe in exercising,
eating right and avoiding tobacco. I try to establish role models and habits.
For our clinic staff, getting flu shots, mammographies, colonoscopies and other
screening tests is encouraged.
Even at Rosh Hashana toasts, we serve cut
vegetables, whole wheat crackers and white cheese rather than burekas, cakes and
sweetened soft drinks.”
She worries about her staff, not only because she
cares but also out of self interest – getting flu shots means they will not have
to take off sick.
Asked to comment, Health Ministry associate
director-general Dr. Boaz Lev surprisingly failed to advocate an activist
approach to the issue. Although he is a jogger who hits the pavement even in 40-
degree Celsius heat at a Dead Sea hotel’s medical conference, he said he saw no
need for a framework to check and monitor physicians’ health.
physician is like everyone else. He is aware of the need for good health,
usually more than others. Some have a personal physician, while others don’t. I
am not aware whether there is more depression and drinking among doctors than
patients. We haven’t checked. We do encourage doctors to get flu shots, but we
don’t force medical checks or treatments on anyone. Physicians,” he said, “are
no different from others. I don’t see a need for a health-promotion program
among them. If I had public money to spent, I would do health promotion for
people who don’t have accessibility to it rather than for physicians,” Lev
Djemal suggested that doctors’ employers – hospitals or health
funds – should offer a free, once-a-year physical exam, as individuals rather
than organized and not with any repercussions on their service.
says that all doctors should be required to register with a health fund personal
physician so they will be less likely to treat themselves.
“I don’t know
if there should be mandatory annual checkups, but there must at least be
independent counselling for psychological problems. A doctor who suffers from
stress or other problems that affect his work needs to be able to talk to a
professional who would observe total confidentiality.”
currently suffers from a serious and growing shortage of physicians, one would
think it worthwhile for the ministry to consider a program that would promote
better health in those we do have.