Medicine in transition

The recent Israel Medical Conference in Jerusalem, attended by over 1,000 laymen, offered experts discussing a variety of relevant subjects.

Prof. Rivka Carmi at the Israel Medical Conference in Jerusalem (photo credit: JUDY SIEGEL-ITZKOVICH)
Prof. Rivka Carmi at the Israel Medical Conference in Jerusalem
Medical care is changing before our very eyes – not only the technological and pharmaceutical revolution but also its human fabric. With the feminization of medical school students – more than 50 percent are now women – more doctors will be needed, as women tend to accept less-than-full-time jobs so they can attend to their families. They also prefer certain specialties, such as pediatrics, family medicine, genetics, geriatrics and gynecology (among others) and eschew such fields as anesthesiology and surgery.
Prof. Rivka Carmi, a trained pediatrician and geneticist who broke the glass ceiling 15 years ago by becoming Israel’s first female medical school dean and, later, first female president of Ben-Gurion University of the Negev, predicts that Israel will eventually have to import surgeons from abroad to meet the need. Speaking at the Israel Medical Conference attended by some 1,000 members of the general public at Jerusalem’s International Convention Center earlier this month, Carmi noted that “most of the decision makers are men. There a relatively very few female medical school professors and department heads.”
But this too will inevitably change, as fewer men go into medicine and instead head for business, engineering, computers and other hi-tech professions.
“There is a big gap,” said Carmi. “It doesn’t serve the needs of the system or of those who use the system.
Some women physicians don’t have the practical ability or the desire to go higher in the system, which is still run by men and unfriendly to women. Men established the medical system, so they designed its environment. There is hidden discrimination.”
There are clear gender differences in the brain, and the abilities of men and women are different, continued Carmi, who has headed committees recommending ways of increasing female representation in the higher echelons of science and medicine.
“Women may have lower ambition and less desire to manage or interest in academia, but they generally do have a lot of compassion for patients. Most are bound to care for their family – with most of the household burden on them – in addition to patients,” said Carmi, who has one adult daughter. “Teaching and research take a lot of time.”
Obstetrics and gynecology used to be run almost solely by men, but not now, she added.
“Women go abroad for post-doctoral study much less frequently than men. Only about nine percent of medical department heads and 1% of deputy department heads are women,” said the BGU president. “And there is pressure on women doctors who go on maternity leave to come back quicker than they want to because their absence puts more pressure on their colleagues in the hospitals and clinics. Women have few role models in medicine.”
A recent study has shown that Israeli women doctors earn 36% less than their male counterparts due to their taking fewer jobs with bonuses for extra work and later hours. Even taking into account differences in age, experience and private work, male physicians take home 27% more.
She noted that the “German Committee” on improving the public health system, which then-health minister MK Yael German initiated and headed for over a year but whose recommendations have been ignored and abandoned by her successor, Deputy Health Minister Ya’acov Litzman, “hardly touched on the feminization problem, which is serious in itself.”
Israel Medical Association chairman Dr. Leonid Eidelman established a committee on women in medicine, and Carmi was a member of it.
“We recommended suitable representation of women in healthcare management and boards of directors.
Now we have to look for them. But some things need the investment of money; other challenges don’t. It’s an international problem, not only an Israeli one, but I think Europe has found more answers than in Israel and the US.”
THE ALL-DAY conference, organized by the Hadassah Medical Organization with sponsors that included two hospitals – Jerusalem’s Shaare Zedek Medical Center and Haifa’s Bnai Zion Medical Center – was the ninth annual event to discuss a variety of subjects related to medicine and society.
Shaare Zedek Medical Center Prof. Jonathan Halevy focused on the key subject of humanization and compassion in medicine at a time when advanced medical technology is such a driving force. The latest shift in the medical profession’s awareness that compassion toward the patient is vital, said Halevy, is evident in books written by Dr. Eric Topol, a US cardiologist, geneticist and digital medicine researcher at the Scripps Translational Science Institute in La Jolla, California.
In 2012, he wrote The Creative Destruction of Medicine, which focused on the revolution of wireless medicine and other technological wonders and examined the impact of the genomic revolution on the healthcare system. He also served on the medical advisory board of a company that performs real-time, wireless electrocardiograms outside clinics and hospitals.
But three years later, Topol published a blockbuster, highly influential book called The Patient Will See You Now, which focuses on the human side of medicine and the need for democratizing medical care and showing compassion.
“A trip to the doctor is almost a guarantee of misery.
You’ll make an appointment months in advance,” Topol wrote. “You’ll probably wait for several hours until you hear ‘the doctor will see you now’ – but only for 15 minutes! Then you’ll wait even longer for lab tests, the results of which you’ll likely never see, unless they indicate further (and more invasive) tests, most of which will probably prove unnecessary (much like physicals themselves). And your bill will be astronomical.”
But the US cardiologist argues that medicine does not have to be that way, that smartphones and intelligent sensors have dragged paternalism out of the physician, who can and must offer the caring and compassion for the patient that computer chips cannot.
Medical technologies, stressed Halevy, “will monitor conditions, and there will be special shoes to help prevent the elderly from falling. There will be no more stethoscopes. But the personal connection doctor-patient relationship will remain as important as before.
The patient will make an appointment not only to get explanations of data but to get empathy.”
At least one US medical school, Icahn at New York’s Mount Sinai, has formally recognized compassion in practice as a subject no less important than any other academic achievement.
“Medical residents there who give all-encompassing care to patients they follow over their three years’ of study have said they find it difficult to say goodbye to them when they finish their studies. This was written up in The New England Journal of Medicine. Empathic care will be prominent in medicine no less than clinical treatment and research,” concluded Halevy.
LITZMAN, WHO recently returned to run the ministry for a second time, stated that Israeli medical care is “excellent, and many countries admire what we have.”
But from his surprise visits to hospital emergency rooms, the United Torah Judaism MK and Gur Hassid said that queues and manpower shortages often overshadow the doctors’ and nurses’ compassion, as they are put under great stress.
“The health system needs a shake-up. Fundamental changes are needed, and we will carry them out through dramatic steps regarding the budgeting of hospitals and health funds, along with closer supervision of the system.”
Another target of the deputy minister’s is to reduce the rate of nosocomial (hospital-acquired) infections, that kill each year an estimated 4,000 to 6,000 elderly and weak chronically ill, as well as the tiniest premature babies.
Eidelman of the IMA noted that 20 years after the national health insurance system ensuring coverage to all, the cancellation by the Treasury of the employers’ “parallel tax” resulted in the loss of billions of shekels to the health system. It was canceled in the hope that employers exempted from contributing to employees’ healthcare expenses would hire more workers and reduce unemployment. But the cancellation, which did not increase employment, resulted in a huge hole in healthcare financing. “We have high-quality medicine, but the availability is not always good enough.”
DR. ESTHER-LEE Marcus, director of the department of acute geriatrics at Jerusalem’s Herzog Psychogeriatric Hospital spoke about medical problems showing up now among octogenarian (or older) Holocaust survivors.
“Many patients of mine had been exposed to undernourishment, consuming only 200 to 700 calories a day. There are long-term influences that we found in studies. For example, those who were incarcerated in concentration camps were three times more likely to suffer from bone fractures that those who survived the Holocaust without being in the camps. The risk of cancer is 3.5 times as high.”
Survivors who were small children during the war and who lacked sun exposure and adequate nutrition were more likely to suffer osteoporosis and bone fractures than those who were older then. There is also a higher risk of heart diseases, stroke and depression among survivors, said Marcus.
AVI DICHTER, a former minister of internal security and director of the Shin Bet (Israel Security Agency) spoke about his work when he was head of the Fund for the Welfare of Holocaust Survivors. “Survivors will tell others that someone who was not there will never understand. They didn’t scream then, because there was nobody to scream to. Their average age today is 84.
In 2007, there were 270,000 survivors; now there are around 195,000. Reforms in recent years have increased funds for survivors by NIS 1 billion, but that comes out to a few hundred shekels a month. Some 4,000 survivors don’t have any relatives or other people who care for them. Time works against all of them,” Dichter said.
HADASSAH UNIVERSITY Medical Center acting director- general and senior oncologist Prof. Tamar Peretz said she and the hospital’s psycho-oncology unit have followed Holocaust survivors and their health for decades, especially those born between 1940 and 1945, who were small children during World War II.
“We found more breast and colon cancer among survivors compared to those of the same ages who didn’t go through the Holocaust,” Peretz said. “They suffered much more stress and anxiety and had less supporter and fewer coping mechanisms.
“The psycho-oncology unit held psychological workshops for some of them, and those who participated gained in the short term, but not in the long term. Yet there were other survivors – and the second generation – who weren’t willing to participate in the workshops at all,” said Peretz.
DR. MARTIN Auerbach, clinical director of Amcha, the organization for treating trauma in Holocaust survivors and subsequent generations, noted that it was thought survivors could not be helped by the time they had reached middle age.
“But it turned out we were able to do it. Others thought that time heals all wounds, but this is not so.
Their situation can be even worse as time passes. Some survivors were obsessively occupied with the Holocaust for decades, while others totally avoided the subject, suffering from sleeping problems, intrusive thoughts, hyper-arousal and other post-traumatic symptoms,” Auerbach said. “Now, with an average age in their 80s, they suffer new losses and fear of death.”
THE NEXT Israel Medical Conference, always held during the steamy month of August, is likely to follow up on subjects raised this year as well as consider new medical topics that the organizers see as prominent in 2016.