BGU | MY PATH, Haim Doron, MD

would best promote medicine in the community - investing in primary internal medicine and primary pediatric medicine, or investing in family medicine. I was adamant that a department of family medicine must be established, but we barely succeeded in convincing anyone to begin establishing such an entity. I recognized that several different efforts would be necessary to vitalize family medicine. One initiative that I embarked on as medical director of Clalit was to convene an international conference on family medicine. The convention was held in September 1972 at the Sharon Hotel in Hertzlia Pituach, just north of Tel Aviv. The gathering had three organizers: Dr. Mendel Pollack, Dr. Jack Medalie, 66 and myself. Dr. Medalie was a very thorough family physician and epidemiologist who had done important work in Jerusalem and Tel Aviv in epidemiology. For the conference, we brought the best family medicine professors from 13 countries in western Europe and the United States. They participated in plenary sessions and in various panels that dealt with all aspects of the field of family medicine -- education, specialization, services, and research. Minister of Health Victor Shem-Tov, who had a very positive attitude towards our initiative, gave the opening speech with greetings on behalf of the State of Israel. Afterwards, Clalit published all the presentations and panel discussions in a special book entitled "Discussions in Family Medicine". Physician-Nurse Team I believed then, and to this day, that advancing quality family medicine is impossible as a solo performance by the practicing physician in the clinic. The doctor must work as part of a team, with the clinic nurse. The nurse does not have just a marginal role of giving shots and applying bandages. Rather, the nurse’s role is to join forces with the doctor to promote all aspects of the patient’s health. Accordingly, I developed a doctor-nurse teamwork model. In a teamwork relationship, the role of the nurse stands at the forefront and is very important to promote good health, educate patients in correct nutrition, physical exercise, and so forth. The nurse also engages in preventive medicine at the clinic by monitoring blood pressure, glucose levels, and other parameters. The nurse must understand the patient’s background, find out what the individual’s family and socioeconomic situation is like, where the person works, etc. Otherwise, there is a tendency to overlook factors such as a person’s occupation and work environment, which may impact on their health. Within the Clalit network we established some 700 doctor-nurse teams both in villages and in the cities. Health outcomes, for example, treatment of hypertension, were better under this model than at clinics that did not operate doctor-nurse team units. Since my first years at Clalit were under the dual-administration system of an administrator and a doctor, I had to convince the powers-that-be to allocate budgets for this. At the time there was a shortage of doctors and a heavy patient load at clinics. That led to dissatisfaction among the public. I convinced the powers-that-be that teamwork would reduce congestion at clinics and satisfaction would grow. This proved true, but from my perspective I did not view teamwork primarily as a vehicle for reducing congestion, but rather as a totally new concept of how best to practice medicine. After I left my positions at Clalit, these team medicine units were abolished. There were a couple of reasons: From a budgetary standpoint, we calculated at the time that to implement the doctor- nurse model in a clinic with four doctors would require adding a half-time nursing position. This was a budgetary issue that needed to be weighed. But in my opinion, if the long term impact was taken into account, it would lead to net savings. Much to my regret, however, the long view isn’t taken into account. Rather, decisions are made by forecasting not more than 66 Prof. Jack Medalie (1922-2006) was born in the United States, grew up in South Africa, and studied medicine in Johannesburg. He served in the Second World War as a physician and then immigrated to Israel in 1948 as a member of the Israel Defense Forces (IDF) volunteers from-abroad, and joined the IDF Medical Corps. In early 1960s, he established the ‘Little Hadassah’ family medicine clinic in Jerusalem’s Kiryat Yovel Neighborhood. He was the first professor of family medicine in Israel; the chair of the first family medicine program in Israel, which was at Tel Aviv University’s medical school; and a founder of the Israel Association of Family Physicians.

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