Retired children’s MD continues to worry about kids

Prof. Emeritus David Branski of the Hadassah University Medical Centers is honored by European gastroenterologists for his decades of service.

By JUDY SIEGEL-ITZKOVICH
Prof. David Branski370 (photo credit: Judy Siegel-Itzkovich)
Prof. David Branski370
(photo credit: Judy Siegel-Itzkovich)
Editor's note: Prof. David Branski passed away on August 1.
The medical treatment of children has undergone significant changes since Prof. David Branski, former chairman of the pediatrics division at Jerusalem’s Hadassah University Medical Centers in Ein Kerem and on Mount Scopus, graduated from the Hebrew University Medical Faculty in 1970 and went on to do his internship at the Ein Kerem Campus.
“Everyone is a specialist in different parts of the body and various systems,” the emeritus in pediatric gastroenterology told The Jerusalem Post in a recent interview. “Pediatricians used to be generalists. It is good that doctors are experts in subspecialties, but this also presents the problem that the holistic view of the child is less in focus,” he said.
The 69-year-old professor – who was born in Tel Aviv, is married and has four children – moved to Jerusalem in 1965 and has never looked back. The latest of his many awards is the prestigious Distinguished Service Award of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), which he will receive in May at the 46th annual meeting of the organization in London.
Branski previously was president of the Israel Pediatric Association and a board member of the Israel Scientific Council. He also served for six years as secretary-general of the European Pediatric Association and was a council member of ESPGHAN and chairman of the gastroenterology committee. Since the beginning of 2010, he has been serving as editor-in-chief of the Journal of Pediatric Gastroenterology and Nutrition Pediatrics, published monthly. He works on the journal from his Hadassah office in Ein Kerem.
Initially, he did not work at Hadassah University Medical Center; instead he was senior physician in pediatrics and pediatric gastroenterology, and then deputy head and chairman of pediatrics at Bikur Cholim Hospital in the center of town. Between 1991 and 2002, he moved to the capital’s Shaare Zedek Medical Center, where he was chairman of the pediatrics department, and then went on to Hadassah.
He has attended the ESPGHAN meeting every year since 1984, thus he will feel at home when he receives the Distinguished Service Award from the association, which has 2,000 medical specialist members from around the world. “The annual meeting was last held in Jerusalem in 1995,” he said, “and it will convene in Jerusalem in 2015,” he said.
He was chosen by a unanimous vote as recipient of the award, said ESPGHAN president Riccardo Troncone. “The award was created by ESPGHAN to recognize an individual who has provided an outstanding contribution to the development of pediatric gastroenterology, hepatology and nutrition. You have been recognized for your lifetime accomplishments in the field of pediatric gastroenterology, particularly for the great contribution given to the development of the specialty in Israel. Also, your longstanding contribution to ESPGHAN has been acknowledged with special regard to the work as editor [of the journal],” he wrote.
Branski was the first physician in his family and therefore had no personal role models in choosing his profession. “My father was a carpenter born in Poland; my parents married there, and came on aliya in the 1930s and escaped the Holocaust. They were lucky! I studied at the Zeitlin Religious High School in Tel Aviv, and I was a troublemaking rascal. I even had to repeat 11th grade. But I finally took myself in hand, worked hard and was accepted to medical school. I always wanted to specialize in pediatrics, as I loved children. Today, I have four children, including a son who works at Intel, a daughter who is a dentist and two sons serving in the IDF. But among my grandchildren, I have two who I’m sure will become doctors and pediatricians.”
“THE CHAIRMAN of pediatrics doesn’t know everything in every field related to children’s health. There is superspecialization,” said Branski. “Now there are experts in subspecialties, and mine deal with diseases of the intestines and of the liver. It was required by reality in the field, which began in such a complicated way that no one could master all topics. The trend began in the 1970s. The downside is that the specialist may not look at the whole patient. This is a problem for both children and adults, in all fields of medicine.”
He himself spent the years between 1976 and 1978 in Buffalo, New York, where he was a fellow at the gastroenterology division of Children’s Hospital. “Young doctors went to the US, and then some to Europe, to do their fellowships. Even today, some conditions are so rare in Israel that patients have to be sent abroad, but we can handle most patients. Every pediatrics department here has a hierarchy, with the chairman running the department but experts in subspecialties handling patients with a problem in their specific field.”
Medical education should be broad, so even doctors who intend to go into a narrow- but-important subspecialty should undergo the widest possible education in the general field like pediatrics, said Branski.
“If a pediatric cardiologist doesn’t know enough about eyes, he won’t be able to pick up certain medical problems in patients. A pediatrician must always be on his toes if he wants to be good at diagnosis. He must do additional courses in general pediatrics to stay in tune with new developments.”
His “message to future generations of pediatricians is that the chairman should not regard specialists as competition and say: ‘I am the boss and I decide.’ Everything should be accomplished to provide the highest quality of services, using experts in the field. We doctors need to be modest, and we must internalize this.”
Another clear change in pediatrics over the last few decades is that more and more women are specializing in the field, as in others such as obstetrics/gynecology. Branski commented that “from my experience, I can see that woman generally have more empathy towards patients than men, and tend to devote more time to find the source of a medical problem and to solve it. Most male doctors are good at this, but women are even better.”
Medical teaching itself is very different today than only a few decades ago. “I learned some things, like the 10 nerves that emerge from the brain, by heart. While one doesn’t need to learn things by heart because they can quickly be located by computer or smartphone, it is important to invest a lot in reading of medical material.
My fellow students and I spent huge amounts of time in the library, looking for material on this or that. Today, a Google search is enough. Physicians must identify symptoms and understand the significance of lab test results to make a differential diagnosis.
I am pleased that medical ethics is being introduced into the curricula,” Branski said. “All change takes time.”
The veteran pediatrician also advocates recognition by the Health Ministry of physician assistants, who study almost as much as doctors and can ease their burden by carrying out tasks that doctors can be spared.
The ministry used to be strongly opposed to this major step, but now realizes it would be the least expensive way to cope with the growing retirement of doctors who emigrated from the former Soviet Union in the 1990s.
As for the choice of students by the five medical schools, Branski said he “knows that some students who will not make good doctors get accepted, while others whose marks are not high enough but would make very good physicians are not.”
“There are simulations, which are good, to pick the best, but there is no proven formula.
A serious personal interview is perhaps the best way, in addition to matriculation and psychometric exam scores,” said Branski.
He is very concerned about the brain drain of Israeli physicians. “Today, the rate is one in 10! We invested a lot of money and effort in training them, so it’s sad to watch so many doctors leaving. We have to find solutions to ensure that they work here,” Branski said, but added he didn’t know whether fines or demands to pay back what the government invested in medical education were the right steps.
Another issue is rotation of department heads. The two Hadassah hospitals are the only ones in Israel to require department chairmen to rotate when they reach the end of a 10-year term – or, at the maximum, after two terms. “Those who leave the chairmanship deserve to have the higher salary; he cannot go down in pay because his professional rank remains the same. Hadassah pays the higher salary,” said Branski. “But the Treasury opposes this arrangement for the other public hospitals, as it costs more money.” Yet, he continues, rotation is important because it bring in fresh blood.
Branski has been very saddened to watch in recent years the financial imbroglio of the Hadassah Medical Organization (HMO), with debts of NIS 200 million (and some say much more), which led to the resignation of HMO director-general Prof. Ehud Kokia, who has not yet been formally replaced. The Hadassah Women’s Zionist Organization of America (HWZOA), which owns the hospitals, “has reduced its financial support to a minimum,” said Branski. “What gives the HWZOA all its prestige and power is the hospitals; it is not the other way around.”
There have been a number of current and former senior HMO officials who have urged that the HWZOA be separated from the HMO so it can raise money for the hospitals independently and receive money from the government, but the HWZOA is sure to resist.
Although numerous medical centers boast that they have “children’s hospitals” on their campuses, Branski recognizes Petah Tikva’s Schneider Children’s Medical Center for Israel – built and opened in 1991 by the late New York businessman Irving Schneider and his friends under the aegis of Clalit Health Services – as the only genuine one that can legitimately claim such a title.
Schneider, he says, has all the departments and services that a children’s hospital needs.
“Hadassah has an impressive Mother and Child Center, but it isn’t a children’s hospital like Schneider. It will be, but not tomorrow; it will happen the day after tomorrow.”
Ironically, many people in the health system predicted that Schneider would be a “white elephant” because it was unnecessary, given the fact that every hospital has pediatrics departments. But Branski said Schneider has proven itself to be a success, and statements that it would be unnecessary “were stupid. There is a lot of jealousy. Irving Schneider deserved all the compliments.”
As for pediatric gastroenterology, this is a “major field” in pediatrics. It includes many congenital disorders, genetic problems and environmental disorders such as infections and diseases that result from poor hygiene.
Celiac disease is one of the diseases involving genetics that can cause great suffering until it is diagnosed and a proper diet is followed.
Branski is an expert in it. “Allergy to gluten can happen at any age, and we know a lot about it – but not why only certain patients get it. If a pregnant woman comes from a family with a history of celiac disease, the baby should be exposed to gluten up to the age of four to six months, and it can help delay its appearance,” he said.
He ends by offering his strong support for the continued fluoridation of the water supply to promote dental health in children.
“There is no doubt that fluoridation has had a major impact in reducing and preventing tooth decay. All children need it, but those from well-off families can be protected by brushing with fluoride toothpaste. But children from poor families are unlikely to brush at all. The ministry has to decide how they can get it.”