The Conspiracy of Silence

Only someone who has ever lain helpless, groaning in pain or on the verge of losing consciousness, in the grip of existential fears, hooked up to tubes and calculating his end, knows the taste of a patient's gratitude to a doctor who has saved him or has rescued him for a moment from his tortures. Only someone who has waited an entire night for the gaze of his benevolent doctor knows the nature of the covenant that is forged in these difficult and crucial moments. The debt cannot be paid by any monetary recompense. However, the disappointment is as great as the expectations: No punishment will atone for the disastrous behavior of a careless, criminal doctor.

In the chorus of mudslinging at the doctors - which is partially justified, though not in its vehemence - the sound of the gratitude to which most of them are entitled has not been heard. The scandals that have broken in recent days - an oncologist who extorts and an anesthetist who falls asleep - do an injustice to a large public of doctors to whom society owes a large debt. There is also disregard for the state's responsibility for some of the deviant and tragic results of the behavior of doctors who have committed crimes or been careless. It is not only toward its patients, but also toward its doctors that the state is behaving unjustly.

Israeli society does not relate with proper gratitude toward its doctors. This is expressed monetarily: If the average monthly salary of a lieutenant colonel in the Israel Defense Forces is about NIS 21,000 and that of a doctor is about NIS 13,000 - including seven days on emergency call, among them three weekends a month - then something is distorted in our scale of priorities. And this is without even mentioning the exceptional salaries in the public sector, from the stevedores at the ports to the lifeguards at the beaches, including employees of the Bank of Israel, whose salary is double and triple that of the doctors.

If the state deems it proper to invest huge sums in futile settlements in the occupied territories, but does not find the money to pay for medications for cancer patients - something is sick in this society. Health is also "security," no less than defense. Maximum levels of success are demanded of the doctors, without rewarding them appropriately and without providing them with fair working conditions. Now there is also a danger that the criminal or careless behavior of a few doctors will make society's attitudes toward all doctors even worse.

The devaluation of the doctor's status began some time ago. After long years of arrogance, during which the doctors became haughty because of their monopoly on knowledge and life, in recent years there has been a counterreaction in society, which has gone to extremes in the other direction. With the help of 20 million medical sites on Google, everyone is a doctor. With the help of the Patients' Rights Law, society has created a defensive wall for itself, to protect itself by law from those who are supposed to save its sick. About a year ago, Professor Avinoam Reches, the head of the ethics bureau at the Israel Medical Association, wrote in the journal Harefuah: "Were it not for our own arrogance, society would not have had to protect patients from doctors." But the counterreaction has been too extreme. Just as the doctors' arrogance was inappropriate, the erosion of their status is also inappropriate.

There is no other profession like medicine: not only in the responsibility for life and death, the patient's total dependence on the doctor at the most critical moments of his life and the invasion of the patient's body, but also in the doctors' working conditions. Consecutive round-the-clock shifts at the hospital, during which doctors are expected to deal with a load that has no equivalent in any other profession, and hours of fateful decisions under terrible conditions make the hospital doctor into someone who is doing nearly impossible work. Four or five minutes on average for every patient, at the order of the health maintenance organizations, which have been becoming stingier in recent years, are also making the general practitioner responsible for a burden that it is doubtful he can bear.

Most doctors work with tremendous devotion, sometimes under insufferable conditions, facing violent families and demanding patients. There are hospitals where word of a patient's death is delivered to family members in the company of the security officer, so great is the danger of violence to doctors. This violence has also come into the emergency rooms, where doctors are sometimes beaten up rather than thanked. With innumerable hypochondriacs, traffic accident victims who come to emergency rooms only in order to squeeze out unjustified insurance money, and street people who come in only to find a bed for the night and a hot meal, the work in emergency rooms is unbearably hard.

Yet nevertheless, Israel can be proud of its level of health services. It is too bad that for this, the doctors are rewarded with disgraceful salaries.

But with all this, it is of course necessary not to ignore the doctors who are extortionate and lax. The medical establishment bears heavy responsibility for them: For every thieving doctor, there are 10 doctors and administrators who know and remain silent. They deserve to be denounced.