Internet medicine is coming: doctors protest

In my last post, I wrote about how I managed to get an MRI done in a hurry by arranging it in Beer Sheva, rather than Jerusalem where I live. The trip was a schlep, but the best part of the experience was actually after the fact.

Rather than needing to call the hospital for the results and then have them faxed to me, I was given a website, username and password and told to simply log in a week later, where my MRI information would all be online. I am happy to report that the system worked as promised.

It’s not the first time I’ve been able to handle medical issues via my computer in Israel. I can routinely check the results of blood tests – they’re updated in real time – and I can also request and receive permission for a referral to a specialist and even make appointments without ever picking up the phone.

Sounds like Israel’s HMOs are finally getting their digital act together. Which was why I was rather surprised to open the morning paper and discover that doctors and the Israel Association of Family Physicians were loudly protesting increased use of the Internet for the very functions I’ve found so useful. The reason: it’s likely to “downgrade the professional status” of doctors.

The complaints so far are being directed at the Clalit HMO, probably following a very public advertising campaign to raise awareness among the public of the new services being offered. Clalit is the nation’s largest HMO with 3.9 million insurees.

Listen to what some of the doctors quoted in the article are saying: “You no longer have to go to the doctor – the clerk in the branch will do what you ask via the Internet.” How is that a bad thing? It saves time for both the patient and physician.

And “this campaign and others continue to destroy the image of the expert family doctor, which was created with great effort – the doctor who specialized for years and is a professional in his field and provides good medical care for his patients.” Oh really, how exactly do you spoil the image of the gruff, abrupt Israeli doctor with no observable bedside manners? Sure, the Internet has no bedside manner, but you don’t expect it to.

The physician’s association was more measured. “There is room for online work alongside a family doctor, as well as for the use of various technologies, but… there should be limitations.” That is, “Internet medicine is good when it’s done in moderation.

Look, no one is saying that a website can replace a doctor entirely, heaven forbid! If my Internet service provider says cough or bend over, I’m making sure that I’m still on the Israelity site and not some “other” URL. Still, anyone who has ever waited hours in a cold Israeli HMO clinic fighting with the other patients over who was there first (“I was after him” is as common at the doctor’s office as in the line in the supermarket), increased computerization is the last thing I’d want stifled.

A Clalit spokesperson got it right: “We have to suit the service to a new generation that wants quick answers and quick service. Medicine is no different from other services, such as those of an electric company or a bank….why can you get forms on the Internet today from any government institution, and only in medicine will people have to continue visiting the clinic and waiting in line? In such a situation, the patient will also develop greater responsibility for his health.”

The services offered by Clalit are still rather limited and can always be superseded by a doctor’s request – for example, in many cases you can renew a prescription automatically over the web, but the doctor can insist the patient come in for an appointment first.

The real revolution – and the one the doctors probably fear the most – is when the HMOs start providing complete transparent access to your entire medical records. Imagine the whining that will arise when you or I can actually see what our doctors have written about us – entirely unmediated by the professional judgment of an inflexible stethoscope.

Clalit hopes to launch the new service by the middle of 2012. Physician: heal thyself.

A mobile MRI

The mobile MRI truck in Beer Sheva

Following the unexpected clean bill of health I received from my “shocking” EMG test a few weeks ago, the search for the cause (and cure) of my sciatica continued last week as I underwent an MRI (magnetic resonance imaging) test. My doctor’s suspicion is that I have a problem on the L5 disc of my spine (whatever that means) and only an MRI can determine conclusively the next course of action.

Of course, scheduling an MRI through an Israeli HMO at any time in, say, the same calendar year is a task that even a young David would defer to Goliath. Hadassah Hospital in Jerusalem would be glad to book me an appointment, they told me…for April 17 at 4:00 AM.

My crafty wife, however, has learned – through unfortunate experience (securing a doctor to look at our daughter’s knee) – how to work the system and found an innovative solution: I would do my MRI in Beer Sheva at the “mobile MRI.”

Apparently, there is a trailer truck outfitted with an MRI machine that travels around the southern part of the country, parking itself for a week at a time in Beer Sheva, Dimona and Eilat. They had an opening – just one week away from the day we called – at an entirely reasonable time (1:00 PM) rather than in the middle of the night. We booked it and I psyched myself up for a pleasant drive into the metropolis of the desert.

To be sure, the MRI-on-wheels is a fully functioning piece of equipment. I can’t say as much for the nurse who needled my arm to open the infusion port that would pump radioactive “contrast” dye into my veins during the procedure. I had a feeling she wasn’t the most experienced nurse in the Negev as she repeatedly tapped my veins searching for the best one.

When I got to the MRI machine and lay down on the table, the doctor quietly scolded the nurse before turning to me to say that they’d have to open a new vein in my other arm (“just to be sure,” he assured me).

As for the MRI itself, if you’ve never had one, it’s an entirely alien experience. You place your head into a secure brace, don noise-canceling headphones and then lie perfectly still on your back for, in my case, about 25 minutes. Nothing spins on the MRI (unlike a CT scan) but there are a variety of noises – whirs and clicks and clunks – as the machine uses large magnets to look inside the nuclei of my atoms.

I passed the time by trying to match the sounds with intros to songs. One rhythmic beat sounded deceptively like the Beatles’ “Getting Better All the Time”; another clearly had the low-tech industrial warble of a Brian Eno solo composition; a third reminded me of the Steve Reich piece “Different Trains,” which played in Jerusalem last year.

I was in and out in just over an hour – perhaps because this was a “single task” facility, the mobile MRI staff were highly efficient. I was back in Jerusalem in time for a late lunch.

Now that the MRI was taken care of, I called up my HMO to schedule a follow up appointment with the back specialist. Yes, they would be glad to reserve me a slot with the doc. He has time on May 28. At least it was in the same calendar year.

Maybe I should see a back specialist in Beer Sheva too.

Israel’s big jump

Israel’s big jump

It’s not something you see every day – or even every 15 years apparently.

Not that anyone other than those that participated actually saw anything, but overnight earlier this week, about 1,000 paratroopers in the IDF conducted a brigade-level parachute jump exercise.

According to The Jerusalem Post, the last time such a drill was held was over 15 years ago, even though soldiers in the Paratroopers Brigade, as well as some other IDF units, continue to undergo parachuting training on a regular basis.

The jump was kept hush-hush, but of course the families and friends of the families knew all about it, which means that most of the country was aware it was taking place. And when the army publicly disclosed the exercise 24 hours later and published photos and video of the jump, proud fathers and mothers scrutinized them for a glimpse of their sons.

According to military assessments, those sons are going to play an important role in any potential future conflict in the region.

“We cannot know what will happen in the changing Middle East and every western military which respects itself needs to know how to parachute large forces, bring them back together and then launch an attack,” Paratroopers Brigade commander Col. Amir Baram told reporters ahead of the jump which was done from Israel Air Force C-130 Hercules transport aircraft over the Negev Desert

The jump went off as planned, and while the commanders were concerned that some paratroopers might be injured during the landing due to the heavy loads they were carrying, the IDF announced that only four soldiers required medical treatment for injuries to their legs.

Take a look at the jump here.



Haagen Dazs not kosher enough for Israel

Haagen Dazs white almond raspberry truffle

I have to admit that I prefer Ben and Jerry’s to Häagen-Dazs. Maybe it’s the fact that Ben went to my college or that their ice cream is simply more available in Israel. But that doesn’t mean I want Häagen-Dazs to go the way of Starbucks, Burger King and Dunkin Donuts, well-known American brands that didn’t make it in the Holy Land.

Nevertheless, that appears to be what’s happening. But not for economic reasons. No, it’s more of the haredization of Israel – now Häagen-Dazs isn’t kosher enough for Israel and the State Rabbinical Authority has issued a proclamation stipulating that any store selling the ice cream with the made-up Scandinavian sounding name will lose its kashrut license.

The reason: the milk that goes into the ice cream is made by non-Jews and not supervised by the official rabbinic authorities. Never mind the fact that religious leaders have for years used milk that is not chalav Israel (that is, made by Jews) under a ruling by none other than leading Jewish legal decisor Rabbi Moshe Feinstein that, due to strict Western regulation, there is no chance that pig products will make into bovine sourced milk.

But that’s not good enough for Israel, where the rabbis have decided that, since we now live in “Eretz HaKodesh,” as Rafi Yochai of the rabbinate’s kashrut division put it, “the majority of the milk produced is supervised [here], so there’s less reason to permit these products.”

Hence the decree that all liquid milk must now be Jewish-made or supervised. Ben and Jerry’s, by the way, uses milk powder (which apparently is still OK) and so, as a result, will still be available.

Not everyone agrees with the new rules. The Orthodox Union, which for years has been the gold standard of kashrut in the U.S., and increasingly in Israel, says it will stand by Häagen-Dazs. But who will sell it? My local SuperSol isn’t going to risk alienating the large number of kosher-adherent Israelis who shop there just for a little white almond raspberry truffle.

A fight for one’s right to consume Häagen-Dazs is unlikely to ignite the masses to return to Rothschild Boulevard, the site of this summer’s social justice protests. And, with increasing rumors of an imminent attack on Iran, it’s unlikely this latest round of religious rigidity will make much of a blip on the culinary radar.

Still, I shudder to think what’s next. No more Toyota cars and trucks in Israel because their carburetors aren’t sufficiently supervised? A blockade on iPhones because the workers in the assembly plants might be eating ham and cheese sandwiches while checking the screens for glitches? A ban on seaweed for sushi because it might contain traces of shellfish (oh, wait, that already happened…

For now, it’s just Häagen-Dazs, though. When asked what the brand’s aficionados should do now, Yochai from the rabbinate replied, “Love God more than ice-cream.”

Immigrant Moments

Changes to immigration law: good or bad for the Jews?

Avraham Michaeli, sponsor of the new bill

I first arrived in Israel in January 1984. At the time there was a rule from the Interior Ministry that one could only remain in Israel 365 days on a tourist visa before one’s “aliyah rights” started to kick in.

For anyone even vaguely considering one day immigrating to Israel, having any of those rights lost or shortened was a big deal financially. They included the amount of time one could buy a car at a discounted rate, similar reductions on rent subsidies, special deals on tuition at university and more.

Since I was planning aliyah, but was in Israel during those years as a tourist, I carefully calculated exactly 364 days in the country and left on that day, only returning when I formally moved here. This represented a significant hardship at the time: I had to leave both my job and girlfriend (the story does have a happen ending: we eventually got married and made aliyah together).

So it was with some surprise when I read a report in Haaretz that a bill in the Knesset sponsored by Shas MK Avraham Michaeli would permit Jews to live in Israel indefinitely on a tourist visa without ever having to formally immigrate (or lose their rights if and when they did make aliyah).

Michaeli’s rationale is that most people, if they stay here long enough, will eventually settle down, vote, and pay taxes like the rest of us, and that forcing them to leave reduces the chances of a future aliyah.

Israeli immigration officials are highly critical, asking why some people should be permitted stay in the country without the burdens the rest of us have – like serving in the army.

The bill has some strong public supporters. Jewish Agency chairman Natan Sharansky supports it, citing birthright as an example and saying, “The more Jews spend time in Israel, the stronger is their Jewish identity and there’s also a bigger chance that they will make aliyah. If you want more aliyah, there should be more Jews.”

Taking the opposing view, a former emissary for the Jewish Agency, Akiva Werber, felt that 27 months (according to rules, revised since my days here in the early 1980s, the amount of time one can now stay in the country without becoming making aliyah or obtaining temporary resident status), was enough to make a decision whether “to share our mutual fate as citizens or not.”

As for me, while such a change in the law would have helped me, I too don’t want to be an after-the-fact freier (the classic Israeli epithet for “sucker”), even if everything worked out just fine.

The bill is probably a tempest in a teacup and is unlikely to pass. After hearing objections, Michaeli instructed the ministries involved to decide “what makes sense from a professional point of view” and report back to him with proposed changes. He said he will consider those changes and then determine whether to amend the bill or continue to push it as is, according to Haaretz.

In any case, the Knesset session on the proposed change has been adjourned for the next two weeks.