Medicine In Israel Research Articles

Special forces medicine in Israel: history and future direction.

The Special Forces (SF) of the Israel Defense Force (IDF) have a long and pioneering history in tactical and medical aspects. Moreover, the importance of medical assistance is highly regarded in the Israeli SF community. Consequently, as current military challenges of Israel increase, the need for SF activity and for its medical support increases as well. Therefore, the authors anticipate that further development of SF medicine (SFM), as a specific branch of military medicine in Israel, will continue.

The growing number of female physicians: meanings, values, and outcomes

Throughout the developed world the proportion of women in professions such as medicine is increasing. This commentary uses Haklai et al’s nuanced report on the feminization of medicine in Israel as a starting point. I discuss whether gender shifts are an outcome of more egalitarian attitudes towards women overall, or instead arise from men choosing other professions, the extent of the shift, and its meaning for the quantity and quality of medical care. The discussion is embedded in more fundamental concepts such as the aims of medical practice and the best indicators of effective care. I reflect on concerns about lower female physician productivity at a time when the proportion of female physicians still remains below parity in almost all countries. Medicine is embedded in the principles and expectations of the community being served. The profession’s values and practices both shape and are shaped by those of that larger community. As cultures move toward equality, proportional representation of women and men in medicine will follow, while remaining limitations to gender equality will be mirrored in opportunities and restrictions for women in medicine. This is a commentary on http://www.ijhpr.org/content/2/1/37/.

The case for orthopaedic medicine in Israel

BackgroundMusculoskeletal complaints are probably the most frequent reasons for visiting a doctor. They comprise more than a quarter of the complaints to primary practitioners and are also the most common reason for referral to secondary or tertiary medicine. The clinicians most frequently consulted on musculoskeletal problems, and probably perceived to know most on the topic are orthopaedic surgeons. But in Israel, there is significant ambivalence with various aspects of the consultations provided by orthopaedic surgeons, both among the public and among various groups of clinicians, particularly family practitioners and physiotherapists.MethodsIn order to understand this problem we integrate new data we have collected with previously published data. New data include the rates of visits to orthopaedic surgeons per annum in one of Israel’s large non-profit HMO’s, and the domains of the visits to an orthopaedic surgeon.ResultsOrthopaedic surgeons are the third most frequently contracted secondary specialists in one of the Israeli HMO’s. Between 2009 and 2012 there was a 1.7% increase in visits to orthopaedists per annum (P < 0.0001, after correction for population growth). Almost 80% of the domains of the problems presented to an orthopaedic surgeon were in fields orthopaedic surgeons have limited formal training.DiscussionWhile orthopaedic surgeons are clearly the authority on surgical problems of the musculoskeletal system, most musculoskeletal problems are not surgical, and the orthopaedic surgeon often lacks training in these areas which might be termed orthopaedic medicine. Furthermore, in Israel and in many other developed countries there is no accessible medical specialty that studies these problems, trains medical students in the subject and focuses on treating these problems. The neglect of this area which can be called the “Orthopaedic Medicine Lacuna” is responsible for inadequate treatment of non-surgical problems of the musculoskeletal system with immense financial implications. We present a preliminary probe into possible solutions which could be relevant to many developed countries.

Pain Medicine in Crisis—A Possible Model toward a Solution: Empowering Community Medicine to Treat Chronic Pain

Pain medicine in Israel and in the world has reached a crisis. The lack of available pain medicine services is resulting in the unsatisfactory treatment for chronic pain sufferers. The main causes of this crisis are: 1) the high prevalence of chronic pain, reaching levels of 17% in the adult population;2) the lack of appropriate training of primary care physicians in the field of chronic pain management; and 3) the paucity of consultation services in the field of chronic pain. In this journal article, we propose a possible model for the solution of the problem, based upon levels of treatment according to the severity of the disease and upon training of primary and secondary care physicians in the treatment of pain. According to the model, the vast majority of treatment and management will take place in the community after appropriate training of primary care physicians. More complex cases will be referred to secondary care community-based pain clinics manned by physicians with further in-depth training. Only the most complex of patients, or those needing specialized treatment such as invasive analgesic therapy, will be referred to tertiary pain centers manned by specialists in pain medicine. Implementation of this model will necessitate training of primary care physicians and the establishment of secondary care facilities and can, in our opinion, pose a pragmatic solution for the hundreds of thousands of patients suffering from chronic pain.

Pain Medicine in Crisis—A Possible Model toward a Solution: Empowering Community Medicine to Treat Chronic Pain

Pain medicine in Israel and in the world has reached a crisis. The lack of available pain medicine services is resulting in the unsatisfactory treatment for chronic pain sufferers. The main causes of this crisis are: 1) the high prevalence of chronic pain, reaching levels of 17% in the adult population;2) the lack of appropriate training of primary care physicians in the field of chronic pain management; and 3) the paucity of consultation services in the field of chronic pain. In this journal article, we propose a possible model for the solution of the problem, based upon levels of treatment according to the severity of the disease and upon training of primary and secondary care physicians in the treatment of pain. According to the model, the vast majority of treatment and management will take place in the community after appropriate training of primary care physicians. More complex cases will be referred to secondary care community-based pain clinics manned by physicians with further in-depth training. Only the most complex of patients, or those needing specialized treatment such as invasive analgesic therapy, will be referred to tertiary pain centers manned by specialists in pain medicine. Implementation of this model will necessitate training of primary care physicians and the establishment of secondary care facilities and can, in our opinion, pose a pragmatic solution for the hundreds of thousands of patients suffering from chronic pain.

Introducing virtopsy into a country religiously opposed to autopsy

Purpose To evaluate accomplishments and challenges in introducing virtopsy to the pediatric forensic post-mortem examination. This in a country (Israel) requiring family consent, with religious opposition from most of the population (Jewish, Muslim, Christian and Druze) to autopsies and even to shipping the body from one location to another before final interment. What lessons can be learnt applicable to similar communities. Materials and methods Data was collected from the National Center of Forensic Medicine in Israel during the 18 month period introducing post-mortem imaging (Group A) carried out in a medical center located miles away from the Forensic Center. There was limited daytime access to imaging devices, resulting in interment delay. The data was compared to the previous 18 months (Group B). The examined parameters were cases submitted, those examined, autopsied or imaged depending on family consent. Results Out of all cases consent to autopsy was similar (A=56% vs. B=54%). Of all cases in Group A, consent for imaging was 24%. Of those imaged, 77% underwent autopsy. Of those examined externally only, 16% consented to imaging. For 7% of total cases in Group A, estimation of cause of death was based on virtopsy alone. Conclusion In a country with high religious opposition to post-mortem forensic procedure, there are challenges to making virtopsy an integral part of the pediatric forensic post-mortem protocol. At this point those consenting to post-mortem imaging are more likely to agree to the performance of autopsies. Even with the difficulties, some we have identified, there was an immediate increase of 7% of cases where a possible cause of death would not otherwise be given. Virtopsy does not breach religious doctrine in Israel, and might partially substitute autopsy.

Defensive Medicine in Israel – A Nationwide Survey

BackgroundDefensive medicine is the practice of diagnostic or therapeutic measures conducted primarily as a safeguard against possible malpractice liability. We studied the extent, reasons, and characteristics of defensive medicine in the Israeli health care system.Methods and FindingsCross-sectional study performed in the Israeli health care system between April and July 2008 in a sample (7%) of board certified physicians from eight medical disciplines (internal medicine, pediatrics, general surgery, family medicine, obstetrics and gynecology, orthopedic surgery, cardiology, and neurosurgery). A total of 889 physicians (7% of all Israeli board certified specialists) completed the survey. The majority [60%, (95%CI 0·57–0·63)] reported practicing defensive medicine; 40% (95%CI 0·37–0·43) consider every patient as a potential threat for a medical lawsuit; 25% (95%CI 0·22–0·28) have previously been sued at least once during their career. Independent predictors for practicing defensive medicine were surgical specialty [OR = 1.6 (95%CI 1·2–2·2), p = 0·0004], not performing a fellowship abroad [OR = 1·5 (95%CI 1·1–2), p = 0·027], and previous exposure to lawsuits [OR = 2·4 (95%CI 1·7–3·4), p<0·0001]. Independent predictors for the risk of being sued during a physician's career were male gender [OR = 1·6 (95%CI 1·1–2·2), p = 0·012] and surgery specialty [OR = 3·2 (95%CI 2·4–4·3), p<0·0001] (general surgery, obstetrics and gynecology, orthopedic surgery, and neurosurgery).ConclusionsDefensive medicine is very prevalent in daily physician practice in all medical disciplines. It exposes patients to complications due to unnecessary tests and procedures, affects quality of care and costs, and undermines doctor-patient relationships. Further studies are needed to understand how to minimize defensive medicine resulting from an increased malpractice liability market.

Complementary and alternative health care in Israel.

The paper explores the patterns of coexistence of alternative/complementary health care (CAM) and conventional medicine in Israel in the cultural, political, and social contexts of the society. The data are drawn from over ten years of sociological research on CAM in Israel, which included observation, survey research, and over one hundred in-depth interviews with a variety of CAM practitioners - many with bio-medical credentials - and with policy makers in the major medical institutions. The analysis considers the reasons for CAM use, number of practitioners, the frequency of CAM use and some of its correlates, and how CAM is regulated. The structure of the relationship between the conventional health care system and CAM is discussed in the public sector, which provides two-thirds of CAM services, and in the private sector, which provides about one-third. The history of the development of these structures and some of the dilemmas of their operation are discussed. A number of policy issues are considered against this background: regulation and licensing, CAM in primary care, reimbursement for CAM treatment, and the inclusion of CAM in education and training for the health professions.

Establishing Pediatric Emergency Medicine in Israel: Reflections and Lessons

This work describes the challenges encountered by the author in establishing and developing emergency medicine and pediatric emergency medicine as medical specialties in Israel. Many of the measures were largely based on his training in the United States, including a clinical fellowship in pediatric emergency medicine at the Children's National Medical Center in Washington, DC, and a research fellowship at the National Institutes of Health in Bethesda, MD. The article covers the clinical precepts on which emergency care is based, their practical applications, administrative obstacles, and new protocols and guidelines. A major milestone was the introduction of guidelines from the Pediatric Advanced Life Support course and other educational activities, followed by the establishment of an infrastructure to encourage local, national, and international educational and collaborative research projects and quality control.

Change and stability: use of complementary and alternative medicine in Israel: 1993, 2000 and 2007

Complementary and alternative health care has gained increasing popularity in Western societies in recent years. The objective of the article is to explore cross-sectional variations and temporal changes in the patterns of complementary and alternative medicine (CAM) consultations in Israel in 1993, 2000 and 2007. Interviews were conducted with 2003 respondents in 1993, 2505 in 2000, and 752 in 2007, using identical questions. The samples represented the Israeli Jewish urban population aged 45-75 in the respective years. The rate of use of CAM during the previous year increased from 6% in 1993, to 10% in 2000 and reached 12% in 2007. Women and highly educated persons have been significantly and consistently more likely to use CAM. Among the users, homeopathy, acupuncture and reflexology are the main types of CAM used. Lower back pain became the leading problem for which care was sought. A significant proportion of the users continue to use conventional medicine concurrently, and an increasing share was referred to CAM by their physician. Past good experience has become a major reason for CAM use. Between 1993 and 2007, CAM use in the Israeli urban Jewish population aged 45-75 years increased significantly. As in other countries CAM grew from an infant industry and entered the mainstream of health care. The evidence reported here highlights the urgent need for the design of health and social policies aiming to achieve more effective integration between CAM and conventional medicine.

Smoking and exercise among future physicians: Survey of knowledge, attitudes and behavior of students at a faculty of medicine in Israel

Smoking and exercise among future physicians: Survey of knowledge, attitudes and behavior of students at a faculty of medicine in Israel

Attitudes of Patients with Diabetes About Complementary Medicine in Israel: A Cross-Cultural Perspective

The Journal of Alternative and Complementary MedicineVol. 15, No. 3 LETTER TO THE EDITORAttitudes of Patients with Diabetes About Complementary Medicine in Israel: A Cross-Cultural PerspectiveEran Ben-Arye, Elad Schiff, Khaled Karkhabi, and Efraim LevEran Ben-AryeSearch for more papers by this author, Elad SchiffSearch for more papers by this author, Khaled KarkhabiSearch for more papers by this author, and Efraim LevSearch for more papers by this authorPublished Online:17 Mar 2009https://doi.org/10.1089/acm.2008.0445AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Attitudes of Patients with Diabetes About Complementary Medicine in Israel: A Cross-Cultural Perspective." , 15(3), pp. 211–212FiguresReferencesRelatedDetailsCited byIntegrating Traditional and Complementary Medicine Recommendations into Clinical Practice Guidelines for People with Diabetes in Need of Palliative and End-of-Life Care: A Scoping Review Susan Arentz, Jennifer Hunter, and Gary Deed14 July 2020 | The Journal of Alternative and Complementary Medicine, Vol. 26, No. 7Evaluation of complementary-alternative medicine (CAM) questionnaire development for Indonesian clinical psychologists: A pilot studyComplementary Therapies in Medicine, Vol. 33The meaning of complementary, alternative and traditional medicine among the Indonesian psychology community: a pilot studyJournal of Integrative Medicine, Vol. 15, No. 4Exploring association of spiritual perspectives with complementary medicine use among patients with Type 2 diabetes in Israel21 September 2010 | Ethnicity & Health, Vol. 16, No. 1 Volume 15Issue 3Mar 2009 Information© 2009 Mary Ann Liebert, Inc.To cite this article:Eran Ben-Arye, Elad Schiff, Khaled Karkhabi, and Efraim Lev.Attitudes of Patients with Diabetes About Complementary Medicine in Israel: A Cross-Cultural Perspective.The Journal of Alternative and Complementary Medicine.Mar 2009.211-212.http://doi.org/10.1089/acm.2008.0445Published in Volume: 15 Issue 3: March 17, 2009PDF download

Integrity during medical studies: Survey at a faculty of medicine in Israel

Integrity during medical studies: Survey at a faculty of medicine in Israel

Thirty Years of Family Medicine Publications in Israel (1975-2004): What, Where, and How Much?

Departments of family medicine in Israel were established in the 1970s. Until now, little or no effort has been made to characterize the productivity of Israeli board-certified family medicine physicians in publishing peer-reviewed scientific articles. Publications were identified by 2 methods. First, a PubMed search by names of current and past faculty from all the departments of family medicine in Israel (1975-2004). Secondly, all of the departments in Israel forwarded a list of all publications by their faculty (including those that do not appear in Medline). The abstracts of all publications were extracted and were separately and blindly evaluated by 2 reviewers. Publications were classified according to Medline citation, language, journal impact factor, and publication type. A total of 1165 publications were identified and analyzed. More than half of the articles were published in the last 10 years. Seventy-two percent were cited in Medline. Publications in English encompassed 64.7% of the publications, Hebrew 34.6%, and 0.7% other. Approximately 6% of the articles were published in journals with impact factor > or =3, with research articles accounting for 46.9%. The publication output of family medicine in Israel averaged 85.4 publications per 1000 family medicine physicians per year. Almost 70% of the articles were published in non-family medicine journals. Academically affiliated, board-certified family medicine physicians published at higher rates, averaging 334.3 per 1000 academic family medicine physicians per year (data available for 2000-2004 only). Publishing and research are important to the development of family medicine as an academic profession, in which Israeli family physicians show significant productivity.

Improving teaching by teaching feedback

Context and setting An interprofessional, international cohort of clinician educators participating in an intensive year-long faculty fellowship programme designed a group project (as part of the programme) on the skills involved in providing feedback. The outcome was a workshop that is still being presented 2 years after the programme’s end. Why the idea was necessary Reflecting on their own teaching responsibilities, the teaching scholars observed that providing feedback to learners was a communication skill essential to their effectiveness, but fraught with challenges. The group reviewed the work of others in the medical literature and in previous workshop formats, and constructed a workshop that allowed participants the opportunity to practise feedback skills. What was done A flexible-format workshop curriculum was developed. It included a didactic component on distinguishing feedback from evaluation, noting barriers and challenges to giving feedback, describing the value of giving feedback in a teaching setting and teaching the following rubric: Ask (to encourage reflection)−Tell (to give targeted feedback)−Ask (to assess understanding)−Act (to plan for future scenarios). Cases were developed to promote practise with the rubric. Small groups of participants observed while a pair within the group role-played an authentic, audience-specific feedback situation. The small group members offered their own feedback about the Ask−Tell−Ask−Act paradigm. As a large group, workshop participants discussed their initial barriers to feedback and identified those that were overcome and those that remained. The Ask−Tell−Ask−Act rubric was reinforced. Evaluation of results and impact Participants identified barriers to giving feedback, which were remarkably similar across medical specialties and professions. The most frequent barrier was the amount of time it takes to give feedback, especially in busy clinical situations. Additional barriers to feedback included a reluctance to give negative feedback, a fear of retribution for negative feedback, and a belief that feedback doesn’t influence student behaviour. By the end of the workshop, participants indicated that their reticence about giving feedback could be overcome through skills training and establishing new group norms about feedback. The innovational element of this workshop lies in its emphasis on behavioural learning by the practise of skills and focused training using scenarios relevant to the participants. Participants rated this portion of the workshop highly, regardless of their varied backgrounds (e.g. medical educators, anaesthesiologists, physician assistant faculty staff, undergraduate and graduate medical faculty in family medicine in Israel). Each group asked that more time should be devoted to role-play. There was also consensus that the simplicity of the Ask−Tell−Ask−Act rubric made it more likely they would use feedback in everyday teaching. Participants suggested that the scenarios include more specific examples about how to give negative feedback. Post-workshop evaluations were not noticeably different by specialty or between US and Israeli audiences in their acceptance of role-play and their desire to spend more time practising in small groups. Follow-up with workshop participants is planned to assess the session’s longterm impact including use of the rubric, the frequency of giving feedback and changes in perceptions of barriers to giving effective feedback.

Who Uses Complementary and Alternative Medicine in Israel?

To describe the Israeli complementary and alternative medicine users and examine whether they are the same or different from non-users. This analysis was conducted on data collected from the use of health services module (n=2,365) of the Israeli National Health Interview Survey conducted 2003-2004. The questionnaire was based on the European Health Interview Survey and was administered over the telephone by trained interviewers. This survey was conducted on a random sample of the Israel general population age 21 years or more. Chi-square tests and logistic regression analyses were conducted. Complementary and alternative medicine was defined as self-reported use of homeopath, acupuncturist, chiropractor/osteopath, naturopath, or other complementary and alternative provider services for the subjects' own health needs in the last 12 months. Almost 6 percent of Israelis reported using complementary and alternative medicine. Use increased with income. Users were more likely to visit any doctor or a specialist in the prior 4 weeks to the survey compared to nonusers. Users self-reported similar use of pain medications compared to nonusers. These findings inform the international debate regarding if and how complementary and alternative medicine services should be covered by national health insurance.

A Study of the Workforce in Emergency Medicine in Israel: 2003

Emergency Medicine (EM) was officially recognized as a specialty in Israel in 1999. In 2003 the first nine Israeli trained emergency physicians (EPs) were certified. This survey was undertaken to assess current staffing of Emergency Departments (ED) in Israel and to attempt to estimate future staffing needs for EPs. A survey was sent to all ED directors at general hospitals in Israel. We asked questions relating to staffing by number of physicians, type and level of training, and differential staffing by time of the day and week. In addition, we inquired as to the census, structure, hospital resources available, and size of the ED. Twenty-four of 25 (96%) EDs responded. There were 59 EM specialists registered in Israel; there were 37 EM residents. EDs reported a total of 1,872,500 visits annually. Emergency care is otherwise given by specialists and residents in other fields, and non-specialist physicians. At large hospitals there is an average of 2.5 EM specialists during daytime hours, and another four specialists of other types on duty. During the night in large hospitals, there is an average of <1 specialist of any kind (typically not EM) on duty. In most EDs, care is turned over to non-specialists (residents and others) during evenings and nights. The recognition of the need for Emergency Medicine as a specialty in Israel has not as yet translated into care of emergencies by EPs for most patients. To adequately staff EDs with physicians trained in EM, an emphasis needs to be placed on increasing EM staff and resident positions. The need seems most acute in medium-sized hospitals and during off hours and weekends.

Satisfaction with Family Physicians and Specialists and the use of Complementary and Alternative Medicine in Israel

Higher utilization of complementary and alternative medicine (CAM) is commonly explained by dissatisfaction or disappointment with conventional medical treatment. To explore, at two points in time in Israel, the associations between six domains of satisfaction (attitude, length of visits, availability, information sharing, perceived quality of care and overall) with conventional family physicians' and specialists' services and the likelihood of consulting CAM providers. This is a secondary analysis of interviews, which were conducted with 2000 persons in 1993 and 2500 persons in 2000, representing the Israeli Jewish urban population aged 45–75 in those years. Bivariate and multivariate analyses were used in the investigation. In 1993, users of CAM were less satisfied than non-users with both family physicians' and specialists' care. Lower satisfaction with the attitude of, the amount of information sharing by and in general with family physicians, and with the length of visits and perceived quality of care of specialists were significantly associated with CAM use. In 2000, lower satisfaction with specialists' attitude, length of visits, availability and in general was significantly related to the use of CAM. Lower satisfaction with family physicians and specialists is significantly associated with consulting CAM providers. However, with CAM becoming a mainstream medical care specialty in its own, lower satisfaction with conventional medicine specialists becomes the most important factor.

Survey of Primary Physicians' Knowledge of Colorectal Cancer Screening

Colorectal cancer (CRC) is the most common of the gastrointestinal cancers in Israel. The low rate of patient compliance to a recent CRC screening program of Clalit Health Services, a major health management organization in Israel, prompted the present survey of primary care physicians' knowledge and practices regarding CRC screening. A 23-item questionnaire, formulated according to the policy of the Israel Ministry of Health and the recommendations of the American Gastroenterological Association, was distributed to 150 primary physicians of Clalit Health Services. The relative ratio of correct to incorrect answers was calculated for every question and by professional group. The response rate was 89%. Total score (out of a maximum 23) was 20.68 for family physicians (experts in family medicine), 17.79 for experts in other fields, and 17.82 for general practitioners (average, 0.90, 0.77, and 0.77, respectively). The score for the family physicians was significantly higher than for the other two groups (P=0.0070). Clustering items by specific issues yielded significantly better scores for the family physicians in four areas: screening (P=0.0164), appropriate test for high-risk population in Israel (P=0.0012), definition of average-risk population (P=0.0012), and CRC symptoms (P=0.0108). A low level of knowledge on the definition of the high-risk population was noted in all three groups. Experts in family medicine in Israel have significantly greater knowledge of most issues of CRC than primary care experts in other fields and general practitioners, although all three groups lack knowledge on the definition of the high-risk population. Continuing physician education should focus on these areas.

Patterns of Use of Nonbiomedical Medicine Services by Nonbiomedical Medicine Providers

The aim of this study was to characterize the patterns of use of nonbiomedical medicine compared to biomedical medicine among providers of nonbiomedical medicine in order to assess the degree of confidence the providers have in nonbiomedical medicine. Anonymous, self-administered questionnaires were distributed among the providers of care in nonbiomedical medicine clinics in Israel. Ninety-two (92) of 127 questionnaires were completed (73% response rate). Fifty-four percent (54%) were women and 76% were Israeli-born. Nineteen percent (19%) had M.D. degrees and 83% received training in nonbiomedical medicine in Israel. In the course of the 12 months preceding the survey, 62% of the providers were treated by nonbiomedical medicine techniques; of these, 54% chose these techniques as their first treatment of choice. The vast majority (97%) expressed satisfaction with the results of this treatment. Fifty-five percent (55%) stated that they would turn to both nonbiomedical and biomedical medicine in the future for acute medical problems; 28% declared that they would turn first to nonbiomedical medicine, compared to 14%, who said they would turn first to biomedical medicine. A similar result was seen for chronic medical problems. More than two thirds of those who turned to nonbiomedical medicine treatment asked for acupuncture. Eighty-seven percent (87%) of acupuncture providers also preferred this mode of treatment. Providers of nonbiomedical medicine care prefer to combine nonbiomedical and biomedical medicine treatment for their own acute and chronic medical problems. The preferred method of therapy was acupuncture. These patterns of use demonstrate that providers have confidence in these methods of treatment alongside biomedical medicine.