BGU | MY PATH, Haim Doron, MD

CHAPTER 5

Vitalizing Family Medicine in Israel

My Outlook on Family Medicine I’ve already mentioned the deep impression that the testimony of medical students from Jerusalem at the Berenson Commission left on me regarding the tremendous gap between the high level of hospital medicine taught at their medical school, and the low level of medicine in the community. This candid admission moved me to set in motion and promote various initiatives to vitalize family medicine in Israel. What is good family medicine? In my view, family medicine is a holistic branch of medicine that sees the human being in his or her entirety. Family medicine must be integrative, medicine that sees the physical and mental sides of the patient as one. I also believe that in discourse of mental health reform today, the role of the family doctor has been overlooked in understanding certain situations in mental health. Family medicine must focus on the entire person not just the specific organ where a problem or disease has been diagnosed. Today, in an era of atomization of specialties, it is essential that there be someone who can coordinate all the aspects of the patient’s health and know how to bridge diverse approaches. Sometimes the specialists are at odds with one another over what is the most suitable treatment. For example, between cardiologists and specialists in hypertension there are different opinions on treatment. The treatments can be contradictory, and it is essential someone orchestrate the treatment for the patient. This is essential to prevent negative drug interactions, particularly in cases of extended illness. Synergizing treatment for the patient is precisely the role of the family doctor. Family medicine must address all stages of health. Its role doesn’t boil down solely to the acute diagnostic and treatment aspects of primary medicine. Rather, it ought to include all stages of medicine - beginning with preventive medicine, medical treatment in the community, and, if deemed necessary, referral to hospitalization and to medical rehabilitation. Sometimes the boundaries between these medical stages are blurry. I, and my predecessor as medical director, Tova Yeshurun Berman, were greatly influenced by Prof. Sidney Kark’s approach. 64 He and his wife, specialists in public health, brought the concept of community-oriented primary care from abroad to Israel. This concept of primary medicine views the situation in the family, in the neighborhood or place where a person lives, and in the community and understands these can all be factors in a person’s health. This approach had a tremendous impact on me. Of course, hospitalization is an episode in the life of a patient that can be very important, but it is not the sum total of all a person’s health components. I see it as our duty to address all health components in the life of the individual. Vitalizing Family Medicine in Israel The first buds promoting family medicine in keeping with this outlook were the initiative of Dr. Mendel Pollack, 65 a family doctor from South Africa and a particularly talented, thorough, and dedicated physician whom one can’t praise enough. Arriving at the Tel Aviv medical school, Pollack set about examining whether it would be possible to establish a family medicine department. At the time there were quandaries in Beer-Sheva over the question of what 64 Prof. Sidney Kark (1911-1998) was born in South Africa, studied medicine in Johannesburg, and immigrated to Israel in 1959. He was renowned for pioneering Community Oriented Primary Care (COPC) in South Africa, Israel, and other places in the world. It revolutionized the face of family medicine. 65 Prof. Mendel Pollack (1929-2000) was born in Lithuania and immigrated to South Africa with his family at age three. He studied medicine in Capetown and then immigrated to Israel in 1962. Head of family medicine at Tel Aviv University’s Faculty of Medicine (1973-1991), he became the first chair of the Israel Association of Family Physicians.

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