Israel’s doctors have consistently shut out other health professions,
usurping their duties all the while bemoaning increasing work loads.
By AKIVA EHRLICH
As an observer of the ongoing interruption of medical services due to striking physicians I, like many others, feel great sorrow at the suffering of patients and their families. However, unlike most, I blame the physicians themselves. The attitudes and behaviors of the physician unions and their supporters in the Knesset remind me of the story of a man at a party who grabbed the food from the plates of all the other guests, and after having gorged himself had the audacity to complain that because of them, his belly hurt.Effective patient care is dependent on the collaboration of physicians, nurses, multidisciplinary therapists, social workers and myriad support staff. Patients and their families depend on the teamwork of all these highly trained, competent and caring clinicians, each recognizing professional boundaries and respecting the expertise of the others.Unfortunately, Israel’s medicos all too often overlook, to the detriment of patient care, other health-care professionals.A central theme of the current strike is that physicians are overworked, especially in medical/surgical wards. Unrecognized, however, is the fact that the physicians are merely reaping what they have sown.Physicians have shut out other health professions, usurping their duties (and often performing them at a less-competent level), all while bemoaning increasing workloads.CASE IN point, immediately before the current strike: Channel 2 aired a documentary in which a film crew followed two young residents during their long shifts in an internal medicine ward and ER in a large hospital. I imagine most viewers felt the frustration and concern of the poor resident as she stood alone in a room with an acutely ill patient in need of respiratory support, or felt pity for the young physician who, while exhausted, woke up after a short rest to take routine blood from patients on the ward.I felt no pity for the physician, as I know something most don’t. Her being overworked is her own fault, and the fault of her colleagues. Why in the world is the resident taking routine blood? That isn’t her job. That is the function of a phlebotomist.AdvertisementNo self-respecting western hospital requires physicians to take routine blood.Are you tired, doctor? Maybe you should ask your hospital administrator why you have taken the job of a technician. Ask your medical director why he or she requires you, a physician, to wake up and perform a task that’s not yours.Why is the resident alone with the acutely ill patient? Because the medical unions and their supporters have blocked the efforts of other highly qualified healthcare professionals to share the load and improve patient care. The resident was alone in that room because the respiratory therapist – the expert in airway management and ventilator support – had her patient-care role stolen, leaving her to deal only with maintenance of ventilators and tubing changes.Instead of having a fully qualified professional assist you and improve the level of care afforded your patient, you chose to be alone.From the registered nurse in the med/surg wards, you took physical assessment, care planning, case management and critical thinking, IV care, Peripherally Inserted Central Catheter (PICC) insertion and wound care, patient and family education, leaving the RNs on these wards to function at the level of unlicensed support staff.You, with the complicity of the nursing unions, have retarded nursing in Israel so that we are generations behind the rest of the western world.Because of you, there are no clinical nurse specialists, no nurse practitioners, no doctoral programs in nursing, no Certified Registered Nurse Anesthetists (CRNA). You even have the gall to cry about the lack of anesthesiologists, and how operations are postponed because of this, while hypocritically closing the door to any development of a CRNA position to assist in operating theaters.Where are the Physician’s Assistants (PAs)? You won’t allow them.Who suffers? The patients.When a rape victim arrives at an ER at two in the morning, why is she examined by a sleepy surgical resident? Where is the Sexual Assault Nurse Examiner (SANE) who has dedicated her career to the competent care of sexual assault victims? I asked that question a few years ago to the director of a leading rape victim assistance program in Israel, and was told that physician groups opposed the development of a SANE licensure program.Who suffers? The patient.Hey doctor, you complain of being overworked? You say patients suffer because you are so tired? How about looking around at the well-trained and eager hands of your paramedical colleagues? Stop shutting us out. Let’s work together. Until then, reap what you have sown.The writer is a hemodialysis nurse, a clinical instructor/nursing educator and paramedic.
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