The Israel Medical Association and once-sterile environments

I would never ask what party my doctor votes for, nor what he or she thinks of the judicial reforms that are currently rocking the country. It is none of my business. So why are they making it my business? Why are doctors putting their politics in my face?

Even with the inconvenience it causes, I support it when doctors and nurses strike because of their working conditions – number of hours per shift and shifts per week, salaries, number of beds in a ward, and other elements directly affecting their ability to do their jobs effectively and to maintain their good mental health in a demanding field.

But when I am suddenly told not to come in for an important medical examination because the Israel Medical Association (IMA) has decided on a 24-hour strike in response to judicial reforms bills before the Knesset, does that make sense? The first reform to have passed and aroused the ire of the IMA is the Reasonableness Clause, which stipulates that the courts cannot overrule political decisions based solely on their own subjective world views, leaving in place, according to legal experts, other legal tools for this when necessary.

I visited Rambam Medical Center late that same morning to ask hospital spokesman David Ratner about the strike. There was only one question I was interested in, a question raised by blogger, Forest Rain Marcia: How was it possible that a government hospital did not prevent its doctors from striking in response to government policy having nothing to do with medical care? Not only having nothing to do with medical care, per se, but, in fact, preventing many, like me, from getting the care we were supposed to get on that day.

Ratner responded that the “medical association is a representative organization and as soon as it issues an official directive to the doctors belonging to the organization, we relate to it as a legal mandate. At the same time, if a doctor decides to work despite the strike – it is his or her right to do so and the hospital will, of course, honour that decision.

The IMA apparently organized transportation so the “white coats” could demonstrate in Tel Aviv to encourage the Histradrut (National Trade Union) to also strike against the new law, and to the Labour Court asked to weigh in on the question of the strike’s legality. A few hours later, the Labour Court ordered doctors back to work immediately. Not so legal, after all.

While Rambam’s administration remained neutral regarding the strike, hospitals such as Hadassah Ein Kerem worked as if there was no strike, and I was told that others, such as Ichilov’s administration took an active part in the protests.

I discovered that some hospitals or medical clinics have/had signs up protesting the government’s judicial reforms and at others, including Rambam, some medical staff treat patients wearing stickers or red shirts with the words: “There is no health without democracy.” That is clear support for the anti-reform protests and does not take into consideration what it feels like for a patient who is in favour of the government’s judicial reforms to be treated by someone donning such a message.

That is what I meant above when I wrote about the doctor’s politics being in the patient’s face. Can this distract the patient from hearing what the doctor is saying about his or her medical condition?

Hadas Ziv, vice president for content and ethics at Physicians for Human Rights-Israel, is not bothered by this. In her article about the strike, she writes that patients are being held hostage by the government’s political games. She further argues that not only does the strike not violate the Hippocratic Oath but, rather, it protects patients — and it is the government that has abandoned them. I wonder if Ziv thinks someone should accompany the public to the polling station on election day to make sure they put the “correct” ballot into the box.

I spoke with Dr. Bella Smolin, Senior Physician in Internal Medicine at Rambam, one of those who did not observe the IMA strike. We did not talk about her personal opinion regarding the judicial reforms but, only her attitude toward the strike. I have no idea to what degree she opposes or is in favour of the reforms. I only know that she has strong opinions regarding the means applied by the leadership of the anti-reform protests and the decision of the IMA to declare the doctors’ strike.

In introducing herself, she said:

I am not right wing and I am totally secular – not close to tradition at all. I am over 50 years of age and have been in Israel for 30 years. I remember from childhood that my parents taught me to think independently, not to let propaganda affect me. I remember my grandmother listening to German radio and my father listening to Voice of America. They taught me about basic principles used by totalitarian regimes that are unacceptable, such that the end justifies the means.

I saw that the IMA is convinced that they are right and, with that belief, they broke a rule that should never be broken – not to bring politics into medicine.

I am a third-generation doctor and my kids are learning medicine too. My mother’s stepfather treated German prisoners of war and when asked how he could treat them, he said ‘I’m a doctor. They are my patients like all other patients. It’s a sacred principle.’

That does not surprise Israelis where terrorists are treated in Israeli hospitals. Smolin continues:

Now they broke this principle by trying to bring politics into medicine. As individuals, each doctor can protest, but as a group, the IMA cannot.

This bothers me more and more as the protest grows. I notice more signs of Bolshevism on the part of the protest leaders. In addition to “the end justifies the means,” if your opinion does not correspond with ours, your opinion does not matter. I see the lying and catastrophizing used to get people out to demonstrate. Saying things like judicial reform hurts the health system is unfounded. It is unconscionable.

Propaganda works on almost everyone. There are few people, and this is not related to their intelligence, who can see through systematic propaganda unless they have been educated to do so. What is happening reminds me of what I ran away from.

I asked Dr. Smolin why the IMA took on this task, such as organizing a rally in Jerusalem on Sunday before the fateful vote in the Knesset the next morning and then the strike when the bill was passed. She responded that IMA chair Professor Zion Hagai is a politician who was in Bogie Ayalon’s political party and, like many doctors, seems to sincerely believe that the reforms are destructive to the nation. But there have been anonymous commenters to articles on a doctors’ website who did not agree that the IMA should be acting as a political body. One should wonder why they comment anonymously.

In the beginning, Smolin was undecided about the whole issue, but when she was thrown out of a group for raising issues questioning the “party line,” she grew worried. Now she is on one of a number of Whatsapp groups of doctors who want the IMA to stay out of politics.

Will others speak up openly like Dr. Smolin about keeping politics out of medical care? Some have begun to cancel their membership in the IMA.

I am left wondering if I will be brave enough to ask a doctor or nurse treating me to remove an anti-reform sticker or to close the white coat so I don’t have to see the red shirt. After all, my health treatment is in his or her hands and I hesitate to antagonize the one upon whom I am so vulnerably dependent. I shouldn’t be put in the position where I ask myself that question.

Feature Image Credit: רונאלדיניו המלך, CC BY-SA 4.0, via Wikimedia Commons