Sunday, August 29, 2010

The Medical System in Israel

Medicine is one of the most integrated professions, with Arab Israelis, Jews, and Russians all working side by side.  My primary care physician is a Dr. Riyan Jihad, and he took off for the beginning of Ramadan.  I'm pathetically unaware of who's Jewish, etc, so I can't tell you if I would have chosen a different doctor in the beginning, but I always come home saying, "Wow, he's so nice." (Not, because he's Muslim, because he's nice compare to other doctors.)  The radiologist who administers Gili's BERA" is a Muslim women and I look forward the seeing the fun colored outfits she wears, though I don't know how she can stand the heat of the hospital in her thick head-to-toe garments.  Many of the nurses are Muslim, especially on the Sabbath.  The patient rooms are also mixed and if you want to see many different cultures all being treated with the utmost care and respect, the hospital is the place to be.  The only reason I care is because I only speak English, and less Arabs and Russians do.  It gets lonely when there are three patients to a room with all their visitors and no one I can talk to.  When we were first admitted I was blessed to be stationed next to a wonderful English speaking family from our city.  I was very new in town and they introduced me to many of the friends I have today.  We still keep in touch.

Even though it is socialized medicine, you can still pay for upgrades in your plan or private insurance.  You usually don't have to wait as long to see a doctor as in the U.S. and paying for private insurance doesn't really change that.  It's more about the perks than the quality of care.  If I need to see a specialist in a hospital or outside our plan, it costs me about $7 for a “Form 17”, but we already reached our max of around $30, so we don't have to pay.  I filled out a form with my credit card and now they will fax the forms wherever and whenever I need them.  The receptionists in Israel are not like the gatekeepers of American doctors.  They are friendly and helpful.  They make appointments and help with paperwork, but they don’t have anything to do with keeping you from seeing or talking to the doctor.  If I call and say, “Dr. Finkleshtien please,” I get to talk to her.  They have been unbelievably helpful through all that we have been through.  Anytime I say I had trouble making an appointment because of my lack of Hebrew or anything, they help me.  

In Israel you sit directly outside your doctor’s door within the “kupot cholim” health clinic and just have to convince the other patients when it’s your turn.  There is no receptionist or nurse who calls you.  There is a list of appointments, but there are always people who try to get in without an appointment.  They eventually get in by convincing another patient of the severity of their illness or of the briefness of their request, “I JUST need…” At the pediatrician I can leave my boxing gloves at home, but I still need to sit as close as possible to the door and be ready to shove my stroller in as soon as it’s our turn. 

Doctors don’t have separate offices for examining patients and giving patients bad news.  The exam table is in the office and you don’t have to take of all your clothes and lay down for every little thing.  Usually the doctor will just walk around the desk and look in your throat.  You enter and give the doctor your “magnetic card.”  They slide it through the slot next to their keyboard and can pull up all your medical records, labs, and even see upcoming appointments in the hospital or with specialists.  I can see the same information if I log in from home, or take my card to a self-serve kiosk in the kupat cholim.  They look like self-serve movie or plane ticked stations. 

Many doctors, including my physician and doctors in the hospital go by their first names.  The workweek is Sunday-Thursday or Friday morning, but don’t try to get anything done in a hospital on Thursday, because people are already getting into a Friday mindset. 

Israeli’s don’t have the same respect for administrators and “gatekeepers” (secretaries and other people who keep you from where you want to be or who you want to talk to.)  We’re one big family and people will argue with a pharmacist or clerk like your worst argument with a brother or sister, but they can be laughing together a minute later.  It is hard to handle, because I am more sensitive to what feel like evil looks or criticism.  And because everyone feels like family, I have lots of “friendly” advice to look forward to as Gili’s developmental delays become more noticeable. 

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