The ERs in Israel are horrible
I exaggerate the title of this letter to make my point. I can only say with certainty, having worked as a gastroenterologist both in Kaplan and Ichilov hospitals, that the care in both emergency departments was and is unacceptable. (I cannot judge other Israeli ED’s because I have not worked in other Israeli hospitals.)
In addition, I am not alluding to the time of thecCorona epidemic when both ERs and staffs functioned exceedingly well. That said, articles like Prof. Mike Drescher’s (“No more ‘emergency room,’ but a ‘department of emergency medicine,’” July 1) are way off the mark when they equate well-trained doctors and nurses in these two institutions with good patient care.
The two major myths I want to debunk are that Israeli ED staffs are overwhelmed and the ED staffs are saints. Mother Theresa is indeed dead, and the portrayal of the haggard ER doctor sweating as she attends the next emergency, with blood stains on her surgical scrubs from the previous tough case makes excellent footage for American TV and the occasional Israeli documentary, but it is inaccurate. It is this very perception by the public at large and the ER staffs themselves, that the unreasonable work load is the cause for these two emergency departments to function poorly.
What in fact did and does occur in both ERs, is that the doctor does an “intake of the patient’s problem” (usually quite professionally), and the nurse takes some blood tests. Then neither doctor nor nurse is seen for the next four hours. For all too much of the time during their shift, the doctors sit at their computer consoles at the main desk, talking to other staff – when pushed, checking the result of a lab test, but rarely getting back to the patient on their own initiative to update him or her on the status of the workup.
Nursing staff “bedside care” is non-existent. Rare is the ER patient who can recall that he got a bedpan quickly, or a nurse offered to help him re-position himself on a hard stretcher, and someone came and actually gave him a sip of water or a cup of hot tea. These observations should not be dismissed as “petty” because the lack of them defines the institutional culture in the EDs in both hospitals
The reason why these shortcomings and many more are allowed to continue, is because in both institutions there is no real accountability to the patient of the ER staff. The accountability I am suggesting has many forms – how much time the doctor himself spends explaining the need for each test; how long it takes to get a patient to the ward he has been admitted to; how long the wait was for a blanket or other item requested; how long it took to take an admission x-ray before being taken to the ward; etc.
Why are experts from a different hospital not given the case ahead of time of a failed resuscitation or that of the patient who died within minutes of being brought into the ER? Who holds the security staff accountable when they are rude and aggressive to frightened families of patients? In other words, despite the benefit Drescher assures us will come when all Israeli emergency rooms evolved into departments of emergency medicine, why was one of he first questions he asked if his own mother was to go the Emergency Department, “Who do I know in the hospital to ensure that she gets good care?”
Well-trained doctors and nurses do not guarantee good care.
STUART A. BECKER MD Tel Aviv