Part 8 Legal Guardianship and Financing Revisited--Third Time's a Charm

by
Shari (Zissie) Gitel
zissieg@walla.com

I think I’m finally starting to get the hang of things now. Our third application for legal guardianship (apotroposut) went fairly smoothly. The most involved portion of the process was getting all the paperwork we needed from my sisters who live abroad. It was not complicated, only time-consuming. Once we had all the paperwork in hand, my sister who lives in Israel and I met at court to submit the application.

In my previous experiences in the Jerusalem and Bnei Brak family courts, we had to make several trips to different desks within the building for each portion of the application. In one case we even had to leave the building to make a payment at the local post office and then return to the courthouse to complete the processing. For the most recent application, which we handled in Rishon LeZion, the procedure was far less complicated:

THE EARLY BIRD CATCHES THE WORM

We got there early and were able to get one of the first numbers to be served (from the machine outside the office where you open a file). As soon as the court offices opened for business I was directed to one of the desks for opening a file. I should point out that there were not very many people there, so in any case, it would not have been a long wait, but you cannot count on that all the time. We were advised to get there early, and that is always good advice to follow.

Of course, we were missing some paperwork. We thought we had it all, but, despite what the social worker at the nursing home had told us, there was one form missing. Fortunately, it was a form we could fill out on the spot. The registrar gave us the paperwork and suggested we visit the desk where volunteer law students help customers in completing the forms correctly. Once we finished that, the only remaining item was to have our signatures verified by an attorney who was located directly opposite the desk of the volunteer students. There was a NIS 40 fee for verification of our signatures. Make sure to have your identity card with you for this transaction.


THERE IS A FEE FOR
SIGNATURE
AUTHORIZATION

Then back we went to the original registrar with our verified signatures and the requisite form. The registrar was quite pleasant and accommodating, even gave us a blank copy of the missing form to present to the nursing home so the social worker would not omit it the next time someone needed to apply for guardianship. She accepted our payment (NIS 470) for the application by credit card and started to send us on our way. That’s when I noticed that my last name was spelled incorrectly on the application she had typed—never a good sign when dealing with computers. We straightened out that little glitch and were done.

Now we are awaiting the court’s decision, which will take approximately two months. When you make your payment you are given a document with the court case number on it for follow-up. Presumably you can make periodic inquiries as to the status of the case. This also enables you to petition the court to act immediately upon your request in the event an emergency situation arises. The social worker at the nursing home has assured us that she will do the follow-up to make sure that things progress at a decent speed.

In the end we only applied for physical guardianship. It is possible to apply for both physical and financial guardianship, but we chose not to after learning of the problems a friend has had in meeting the court’s requirements for such guardianship. Among other things the court requires opening of a separate guardianship bank account, as well as detailed itemization of income and expenses. Also details of assets for the past seven years have to be itemized. Our friend has no idea how to go about itemizing everything, and doesn’t even know what her parent owned or did not own seven years ago, let alone the value of it. Since I am an authorized signatory on my parents’ checks, we are postponing this aspect of the guardianship, at least for the time being. It just seems like too much additional aggravation if we can get by without it.

KEEPING TRACK OF ALL THE PROCEDURES SOMETIMES FELT LIKE A JUGGLING ACT

Simultaneously we had reapplied to Lishkat Habriut for help in financing payments for the nursing home. For better or for worse, the value of the dollar had dropped dramatically, making it impossible for my parents’ social security income to cover their nursing home care costs. The whole process had to be restarted from scratch—same forms (with a few additional thrown in for good measure), same committee review. It took a little longer than originally promised, but eventually we received the answer we had long awaited: the Ministry of Health would finally assist us in payments. My sister in Israel was assessed a monthly fee based on her income, and my parents would have to pay their social security income to the Ministry of Health. This would cover part of the nursing home fee, while the Ministry of Health would pay the balance, including any medications approved for the “basket of medications.” According to the manager of the nursing home, the Ministry of Health also pays for the patient’s ambulance costs and diapers.

I believe that pretty much brings this tale up to date in my adventures with the various branches of bureaucracy I’ve had to deal with while parenting my parents. There may be more surprises waiting down the road, and you can rest assured that if there are, you will hear about them. It’s been quite a learning experience for me, and I hope you’ve also learned something from my trials and errors. Good luck in your own personal journey down this never boring road. I hope you encounter no bumps or detours, but if you do, and I can be of any help, please don’t hesitate to contact me.

Stay tuned for my next post, where I hope to deal with the range of emotions associated with the trauma of caring for a loved one with a deteriorating condition.

And now, I think I’ll work on a project that has been weighing on my mind since I began this journey—getting my own house in order, both literally and figuratively.

TIME TO GET MY OWN HOUSE IN ORDERI sorely need to learn more about handling family finances, a realm that until now my husband has single-handedly controlled. I’m going to make sure my will is up to date (why else did I send my daughter to law school?). And I’m going to do a clean sweep of all those things I just had to hang onto that in truth I no longer need and just add to the clutter of my home. Last, but not least, I’m going to work off a lot of tension that has built up in my system and find a healthy outlet for all that energy—after all, why else did God create tennis courts?
Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 7: When Push Comes to Shove—a Journey of Epic Proportions

By Shari (Zissie) Gitel
zissieg@walla.com
Caught between a rock and a hard place
It was bound to happen eventually, and indeed it did. One foreign worker was no longer enough help to care for my parents. For a while we were able to manage with a foreign worker plus occasional help from a local caregiver. As time wore on, however, we began weighing the option of either hiring an additional full time foreign worker or admitting my parents to a nursing home. Neither one of the options was attractive: the conflicts that might arise between two foreign workers living together under one roof (one male and one female), although it would be affordable, appeared formidable (and I am not even certain whether by law it would be permitted); the impersonal atmosphere of a nursing home and the indignities it probably afforded were no more palatable. We were caught between Scylla and Charybdis. The cost of the nursing home, itself, was way out of my parents’ reach. Even if we located one that met our needs, how would we be able to afford it? To make matters worse, the foreign worker we had in our employ was seeking to move to Canada. We were faced with retraining someone new, if not two new people. The scales started to tip in favor of care in a protected environment.

What do you call a Jewish Odyssey?
Thus began the Odyssey of searching for an appropriate nursing home and the means to pay for my parents care. In our ongoing epic we became familiar with the Ministry of Health as well as the Ministry of Welfare, who vie against each other in funding of nursing home care—neither one of them wanting to assume responsibility for it. Patients in need of care in a protected facility are categorized in a number of ways. For our purposes the two categorizations that applied to my parents were either tshushi (frail) or siyudi (requiring more extensive nursing care). The Ministry of Welfare funds tshushi care, whereas the Ministry of Health funds siyudi care. Bituach Leumi funds nothing towards nursing home care. And here’s how the process goes:

One must apply to the Ministry of Health through Lishkat HaBriut to see whether the patient qualifies for nursing home care, and whether the patient is considered tshushi or siyudi. The initial forms comprise medical reports completed by the patient’s physician and nurse detailing the patient’s degree of functioning (ADL’s again), as well as additional medical documentation of specific diagnoses by specialists when dementia is present (from my experience). In addition there are forms for the social worker to complete. This information is submitted to the Social Worker at Lishkat HaBriut, who reviews the forms in a meeting with you to ascertain that all the necessary information is available for submission to their medical committee for review. The review committee meets every couple of weeks to render decisions.

NOT ALL NURSING HOMES ARE RECOGNIZED BY MISRAD HABRIYUT FOR FUNDING—IF FINANCIAL AID IS REQUIRED, MAKE SURE THE FACILITY OF YOUR CHOICE IS RECOGNIZED AND HAS A “CODE”.

When we first submitted our forms for the review committee, we were contacted and told that some committee members would have to examine my parents at their home. Apparently it was not clear whether they were siyudi or tshushi. A nurse and social worker from Lishkat HaBriut arrived for the examination and were of the opinion that one of my parents was siyudi while the other was tshushi. I explained how we wanted to keep them together in the same room in a nursing home, and if they were categorized differently that would be impossible. (Not only that, we would have to deal with two different government entities for financial support, if indeed they did qualify.) The crew informed us that they would make their recommendations to the committee and we would be hearing from them. Then we again played the waiting game.

PARDON ME FOR CHANGING
MY GENRE, BUT HERE'S WHERE WE HIT "CATCH 22"


Nursing Home Sweet Nursing Home
While we waited we toured several nursing home facilities in the area, while my sister did the same where she lives. We were in for a rude awakening when the nursing home administrators looked at my parents’ medical records and forms listing their functioning capabilities. They predicted that my parents would fall between the cracks—they actually required siyudi care, but would, from past experience, most probably be classified as tshushim by the Ministry of Health. In that case my parents would fall under the responsibility of the Ministry of Welfare. If the nursing home maintained they required siyudi placement, no government funding would be available. Both bodies—the nursing home and the Ministry of Health—must be in agreement in the categorization for the patient to qualify for financial coverage—be it the Ministry of Health for siyudi patients or the Ministry of Welfare for tshushim. Nevertheless, we plodded on in search of a place suitable to deal with their needs and with a religious atmosphere appropriate to their background and observance. English-speaking staff was also important to us. Proximity to either my home or that of my sister was a priority, and the cost played a major role in our decision making. No one place met all our conditions. Time was running out. We decided to waive some of our preconditions and opted for what we believed was the best choice at the time. We will never know if the choice we made was the right one, but given the time constraints and the condition of my parents we could not be too choosy.

I STRONGLY RECOMMEND STARTING THE NURSING HOME SEARCH
BEFORE YOU ARE UNDER PRESSURE TO MAKE A HASTY DECISION

The committee proved to be compassionate and categorized both my parents as siyudi, effectively guaranteeing they could be housed in the same department, and most probably (depending on the availability) in the same room of the facility they chose. Not only did this relieve our anxiety about their transfer to a new place, it also made my parents more receptive to the idea of this drastic change. No matter what difficulties they might have in adjusting to the new situation, at least they would be able to face them together, as they had throughout their lives. Plus we had a definitive answer as to which government body would be in charge of the financial aspects and were able to avert the hassle of a power struggle between two government offices.

I hope you haven’t forgotten about all those forms you always have to fill out. We had only just begun. Now that the medical portion of the application had reached its close, we were faced with the financial reporting. Application forms are available online. There are forms to be filled out regarding the patient and his/her spouse’s finances and property, as well as forms regarding the finances of each of the patient’s children residing in Israel. Monthly salary printouts of children working in Israel must be supplied for the three months preceding the application. When we first applied (and were rejected, because my parents’ finances were just borderline enough to allow them to “get by”), there were fewer forms than what are required now. Recently Lishkat HaBriut has added more forms to those previously requested. The patient and his/her children also have to provide a listing of assets such as property and automobile, bank account information and documentation of property holdings. How do I know this? I have just re-applied for financial support and am still awaiting an answer.

As an aside, what put my parents over the limit financially was the fact that they each had a nursing care insurance policy that we had activated when they started paying for in-home care. This additional monthly income just put them over the edge. If you are considering purchasing nursing home insurance (bituach siyudi), carefully weigh the pros and cons. You may be paying more in monthly premiums than is worth your while. This, of course, depends on your financial situation. For someone who has a limited fixed income and who will require government help for nursing home care, it may not be cost-effective to invest in additional nursing home insurance. Do your own calculations and research to see where you fall in this area. There is an excellent article which appeared in Ha’Aretz describing the pros and cons of investing in this type of insurance.

Epics don’t necessarily have happy endings
To make a long story short, we resettled my parents in a nursing home near my sister. Having been assured by the marketing manager that the staff spoke English and the religious atmosphere coincided with my parents’ traditions, we toured the facility and were favorably impressed with the care and accommodations. It wasn’t the Waldorf-Astoria, and the synagogue didn’t boast any famous cantors, but it was clean, well-staffed and met the physical demands of my parents’ condition.

Soon it became apparent, however, that not all the staff spoke English—in fact very few of them did—and this has been the source of much aggravation. I can speak Hebrew. My sister can speak Hebrew. My father understands Hebrew reasonably well and can make himself understood in the language. My mother neither speaks nor understands Hebrew—no matter how many times you repeat the question or statement or how loudly you say it, she still will not understand it. Regardless of how many times she tries to express what she needs or wants, the staff is totally baffled by the foreign language she speaks. She is an ulpan (Hebrew classes for new immigrants) dropout and now sorely regrets it. The alternate languages that may have helped her communicate in her current environment are Amharic and Russian, and perhaps some Yiddish. She struck out in all three. So, when I say it is important to learn Hebrew, I mean it. You cannot afford to be reliant on a translator when you have to fend for yourself. If you haven’t learned Hebrew yet, now would be an excellent time to start.


BE KIND TO YOUR CHILDREN… THEY’RE THE ONES WHO WILL CHOOSE YOUR NURSING HOME.
If you find yourself in need of approaching the Ministry of Health/Lishkat HaBriut for the purposes of financial aid, be aware that the hours of service are quite limited. In my area they receive the public one morning and one afternoon per week, and are available for phone queries three mornings a week for about two hours each morning. See the link for the various offices and their contact information to ascertain the hours applicable to your area. Our experiences with the personnel have been quite positive. They have been caring, informative and helpful. Regretfully, even their willing personalities do not get the bills paid if the patient does not meet the standards dictated by the system. We fell short and for several months have had to bear the burden on our own. Nevertheless, I know that we made the right decision to place my parents under constant medical supervision. As painful and expensive a decision as it was, I can see now that there is no way we could have continued catering to their growing needs in a home environment. It was not fair to them, and it was not fair to us.

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 6: The People You Meet Along the Way

by Shari (Zissie) Gitel
zissieg@walla.com

Preface
Some of my closest friends and relatives are doctors and nurses. I wonder how they'll feel after reading this post.

Introduction
I debated long and hard whether or not to include this column, because it really does not provide any guide to services available. Rather it reflects my feelings of frustration with the system. So, I won’t be insulted if you choose not to read this post. If, however, you do choose to read it, and your feelings resemble mine, maybe you can add your voice to mine in trying to improve how we are treated by members of the health professions.

I’d like to talk about the people I’ve met along the way on this challenging road. As you can imagine they come in all kinds. Somehow those that manage to get under your skin are the most memorable, unfortunately, and we tend to forget the many wonderful people out there who really care. I believe in giving credit where credit is due, and I also believe that inexcusable behavior should be brought to the attention of those in authority. In the process I have become an expert letter-writer. Some of my more successful letter-writing experiences will remain secret, as part of the legal agreement we reached restrains me from implicating the institution at fault. My apologies in advance to every person in the health field whose performance characterizes how people in the medical profession should act.

A Trip Down Memory Lane
So let’s take a trip down memory lane and review some of the highlights, instances that provoked some of my letters of commendation and condemnation. There is no excuse for rudeness, particularly when dealing with those who are ill and the family members who are frazzled enough by coping with the illness that the last thing they need is the apathy or outright nastiness of the very people who control the fate of the patient. To me it seems that anyone who has chosen medicine as a profession would actually strive to be courteous and helpful to patients and their caregivers. Why then is it that when I have to go to kupat cholim I start to break out in a cold sweat, my blood pressure rises and my stomach starts turning somersaults? Could it be because I know what’s in store for me there? Before I even start dealing with solving the dilemma of the day, the mood is set by the patients around me. Does this prelude to dealing with the receptionists sound familiar?

"I have to (insert your favorite excuse), but I’m after you in line if anyone else comes.”
“I don’t care what time your appointment is scheduled for, my number is before yours, so I’m going in first.”
“I was here earlier and just have to ask one more question that I forgot.”
“I’m only here for a prescription—it will take just two seconds.”

WHY DO I BREAK OUT IN A COLD SWEAT JUST THINKING ABOUT GOING TO KUPAT CHOLIM?

And the list goes on. Then, when at long last it's your turn to sit down and discuss your matters you get “the attitude” from the clerks. They seem to indicate that you are nothing but an inconvenience that has shown up to bother them with your petty problems when it’s time for a coffee break. Often you get the feeling that they are trying do everything within their power to throw as many obstacles as possible in the way of your achieving your goal. I do not believe that “the customer is always right.” Of course, there are times when the customer is wrong, but the preconceived attitude that the customer is a nuisance non-deserving of a helping hand is a far cry from providing a service, especially a medical service, adequately.


The Customer is Not Always Right

I will be the first one to admit that many times I have been in the wrong. One of those times I not only messed up which date my father was supposed to arrive for his test, but also showed up there without the Tofess 17-Hitchayvut (the form stating the kupat cholim’s agreement to cover the cost of the service) and the orders for the test. It’s a long story. I’m not usually so absentminded. The test had been set up a month before by the hospital where my father had at the time been hospitalized. A few days after his discharge, the nurse from the hospital phoned me and told me they had set up an appointment for an outpatient test for him on such and such a date. I asked if he needed any paperwork to take with him or any hitchayvut, and she said that it was unnecessary because the hospital had taken care of providing all the details to the testing facility. I admit I should have done my homework, but I accepted what the nurse said to be accurate, recorded the date and time in my Palm Pilot, and we dutifully showed up for the appointment on the date the nurse had told me. Well—you can imagine my surprise when we arrived and the receptionist informed me that my father was not scheduled for a test that day. The test was actually scheduled for the same date but the following month!! I looked at the receptionist pleadingly and pointed out my father. I explained his frail condition and how difficult it was to transport him. With a sympathetic look she told me she would see if they could fit him in anyway that day. Then she asked for the requisite paperwork. I told her that the appointment had been set up by the hospital while he was an inpatient, and they had assured me that no paperwork was needed. You should have seen the look of incredulity on her face. She explained that without the orders and the hitchayvut they could not perform the test. But, she told me, she would try to contact the family doctor’s office to get them to fax the necessary paperwork on the spot. And that’s exactly what she did. In the twenty years or so that I had been living in Israel this was the first time I was presented with a real live caring individual who, although she would have been perfectly within her rights to send us packing, went out of her way to help the patient. After I recovered from the shock and thanked her a million times, I left my father sitting supervised in the waiting room while I went and bought pastries for the whole staff.

Then there is the kupat cholim receptionist who, when I asked her for advice on how to go about getting a hitchayvut that would cover monthly hospital treatments for a whole year, saving me the time of having to request and pick up the hitchayvut each month, told me that to her “the patient is king,” and she will run the paperwork through to the highest levels of administration to make sure it gets done properly, saving the family the aggravation of having to deal with all the red tape. After all, she said, if you’re going to do a mitzvah you should see it through from start to finish.


There Really are Some Angels of Mercy out there in the Medical Field

How about the doctors who, when they see how hard it is for the patient to come into their hospital examining room, actually go out to see the patient and speak to him/her in a more spacious area, saving the patient and the family the difficulty of navigating small spaces and getting up and sitting down numerous times? Or those who unsolicited phone the patient’s home to check on the patient’s recovery? There are even some who cheerfully make house calls without any reference to how much they have to go out of their way to do this and how pressed they are for time. Rare breeds, these doctors.

If you are in the medical profession and don’t recognize these dispositions as part of your makeup, you should ask yourself, “why not?” What has made me so callous that I act in a way that belittles the importance of the patient and his/her family as human beings and turns them into “cases” referred to by their diagnoses rather than their names who, to me, only represent added paperwork? Why should a patient be forced to feel that his/her respect and dignity are being violated by the sometimes flippant attitude directed towards him/her—anything from ignoring his requests to outright disrespect of his privacy, acting in an unprofessional manner often bordering on total negligence?

How would you like a dose of your own medicine?
Now I’m about to do some serious receptionist/nurse/doctor bashing, so, if you don’t want to hang around for it, stop reading now.

Before coming on Aliyah I worked as a medical assistant, first for an oncologist for 10 years, and then for a group of neurologists for about 10 years. I’ve seen pretty much the worst of what can befall humans when illness or accident strikes, and I’ve worked with some wonderful, caring medical practitioners who have gone beyond the call of duty to reassure family members, to work extra hours, to treat patients with the dignity and respect and compassion that is their due. My husband also worked in the medical field in hospitals both in the USA and Israel, and we both are privy to what goes on in that world. We have sat at both sides of the desk, so to speak, and have come to know some very considerate, polite, and compassionate professionals in the field of medicine.

It is the others that give medicine its bad name. What happened to the work ethic of performing your job to the best of your abilities? Not slacking? Not looking for every reason to avoid having to put in a little extra effort to bring a result that will be agreeable to both the service provider and the recipient? The motto of many of these workers seems to be “Work slowly and carry a big lip” (with apologies to Theodore Roosevelt).

The Hierarchy of Power and its Abuse
The receptionist, who is first in the line of hurdles to overcome, wields an enormous amount of power in his/her small corner of the world. And in many cases he/she will try to demonstrate to you just exactly how much control he/she has over the outcome of your request. These workers are no doubt underpaid and unappreciated, and the quality of their work usually reflects the grudge they bear on these accounts. This, however, does not excuse rudeness and unwillingness to do the job properly. You can accomplish much more by doing something right and thoroughly the first time than by cutting corners and trying to see how much work you can save yourself. If you’re sitting there already, you may as well smile and be user-friendly.
If You Aren’t Doing What You Love, At Least Love What You Are Doing

Let’s move on from pkidim/ot (clerks/receptionists) to the next human in the medical hierarchy—nurses. There are many species. For instance, the nurses who will do nothing more than the minimum to care for you, and act like they’re doing you a favor to boot. One of my favorites was the nurse at the specialist’s office who started yelling at me for not following her instructions properly in exposing enough of the patient’s body for the test she was going to perform. (God forbid that she should overextend herself and pull the clothing down another two inches on her own. Maybe that wasn’t part of her job description.) I lost my temper and yelled back at her, because her outburst was so uncalled for. It was amazing how, when I asked what her name was and started writing it down, she became the absolute picture of courtesy and developed a sweet personality.

Her nastiness pales, though, in comparison with that of the impudent nurse who told me she could tell I was “the daughter-in-law and not the daughter of the patient,” because, had I been the daughter of the patient I would have shown more concern and would have brought an undershirt to put on her for going home. There I was—all alone with a demented wheelchair-bound woman, taking care of releasing her from the hospital, arranging for an ambulance, dealing with discharge reports and all the other bureaucracy involved in getting my mother-in-law from the hospital to her nursing home, and I was greeted with the audacity of that nurse. I thought perhaps I had misheard what she said because it was so outrageous, so I asked her to repeat it, and sure enough that’s what she had said. It totally unglued me. I could hardly describe to the head nurse what had happened to upset me so much because I was crying and trembling so hard. That nurse was immediately called into a room for a good bawling out by the head nurse in charge, and, when I calmed down sufficiently a few days later, I wrote a scathing letter describing the incident to the hospital director. I have more stories about less than exemplary nurses but if I told them all, this article could go on forever.

Contrast this with the visiting nurses who are usually models of kindness and patience. They take the time to listen to the patient and to teach different techniques to family members unfamiliar with procedures necessary to care for the patient. I don’t envy any nurses, with the complicated and often unpleasant tasks demanded of their job. I hold in high esteem those nurses who are truly dedicated and proficient. Without them the patient and family would be at a total loss. If only there were more of them around...

Ahhh, now we come to doctors. There is some question whether they come below or above the nurses in this hierarchy, but for our purposes we will put them at the top. It is beyond my understanding why there are so many doctors (I’m referring primarily to doctors on staff in the hospitals) who treat patients and their families like some kind of dust they have to brush off their clothing. I enclose links to several oaths recognized by the medical profession, namely the Hippocratic Oath (for doctors), Maimonides Physician’s Oath (apparently a prayer he said before he started working each day), and The Nightingale Pledge (used by many nursing schools when nurses achieve their R.N. degree). Nowhere do I see a reference in any of these oaths that family and patients should be treated by doctors and staff like they are not deserving of courtesy and compassion. I’m reminded of one of my favorite stories:

A Jewish man dies after having lived a long observant life. When he enters the Gates of Heaven, he is warmly greeted by the welcoming angel and escorted on a tour of the grounds. They start walking along, and the angel points to a bearded gentleman sitting outside a tent, “That’s our forefather Abraham,” he says to the newcomer. Jacob stares in awe and can’t believe he is actually in the presence of such a renowned person. They walk on a little and come across a man with a glowing face polishing two tablets. “You probably realize that that is Moses,” the angel says. “And over there you can see King David and King Solomon.”

“Wow,” Jacob says to himself. As they continue their tour he notices someone walking along in a white coat with a stethoscope slung around his neck. Everywhere this guy goes people bow their head to him. He turns to the angel and says, “Who is that? He really must be somebody important the way everyone is treating him.” And the angel says, “Oh, Him, that’s God—He thinks He’s a doctor.”

WHAT EVER HAPPENED TO THE HIPPOCRATIC OATH?



Shall I start with emergency room doctors or ward doctors? They are pretty much the same in their behavior patterns. ‘Don’t bother me now’ is the general attitude. Well, in the emergency room, if I wait for later, it may be too late. I personally know someone who suffered this fate, and the litigation is still in progress. And, in the ward, if I wait to talk to you during your posted hours, the chances are 50/50 you will actually show up there, and why should I once again lose a whole day’s work waiting for someone who may or may not show up to speak to me? And, if I accidentally ask you a question that is beneath the dignity you ascribe to your level of expertise and not part of your job description to deign to answer, do not contemptuously say “I’m a doctor, not a receptionist.” A polite “I’m afraid I don’t know the answer to your question but I think …. can help you,” would be received with much more understanding.

Finding a Cure
Is there a solution to this attitude problem? Probably not. I think all medical professionals should see the film The Doctor, starring William Hurt, based on a true story described in the book written by Dr. Ed Rosenbaum (and subtitled “A Taste of My Own Medicine”), and read the book Tuesdays with Morrie by Mitch Albom, just for starters. Frequently I will make a comment to a service employee such as “If you smiled you would look so much more pleasant.” To those employees who indeed go the extra mile I shower praise and comment on how wonderful it is to be treated so graciously. I write letters not only about those who disappoint me but also about those who are outstanding in their approach. Whenever I can, I tell them that I am going to write a letter in their praise and try to ascertain exactly to whom the letter should be directed to have the most impact. I don’t know that my letters help, but I would like to think that maybe, little by little, we can make inroads into improving how we as recipients of treatment during critical times of our lives can at least feel that those who are out there to help us through those times really do care.

You, too, can state your opinion when you see an injustice or some extraordinary behavior worthy of comment. Perhaps together we can make a change.

*********
Originally I was going to end this column right here. I decided, however, that in all fairness something should be said about us as consumers and our attitudes. It is incumbent upon us to be as courteous to the person serving us as we would expect them to be to us. Coming in with a fighting attitude and aggressive behavior does not serve our purposes. It immediately puts the other person on the defensive and sets up a barricade before we even get started with our negotiations. So let’s all try to set an example, and we just may be able to work out our problems to everyone’s satisfaction in an atmosphere devoid of animosity and dedicated to achieving what is in everyone’s best interests.


For your reading pleasure I enclose a link to the Patient’s Bill of Rights and some tips for writing effective letters.

Letter Writing Tips:
1) Organize your thoughts on paper omitting any emotional references
2) Ascertain the title, name and address of the person in authority to whom the correspondence should be mailed
3) Compose the letter sticking to the facts with as much detail as possible

• Date
• Time
• Location
• Patient Name
• Employee Name
• Unemotional description of the incident
• Request for action, whether disciplinary, monetary or to draw attention to behavior worthy of emulation
• Signature and contact information
  

Guide to Services for the Aged and Disabled in Israel
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