The Israeli Medical reality

I'm writing this entry some weeks on from the actual occurrences - it's been a very busy few weeks and it's a shame that I haven't kept the journal up to date, as things really start to slip out of memory.

This week marked the real start of my elective learning. I saw so much interesting stuff, and very conveniently, the patients came in clusters of similar conditions, which has been great for my differential diagnosis learning. (eg 5 patients with stomach pain in one morning - one with gastroenteritis, one with polycystic ovaries, one with mittelshmertz, one with pseudo-obstruction, and one with acute appendicitis).

I'm not used to the look of horror on a Doctor's face

I've seen some nasty head injuries, catheterisation (the urinary and cardiac varieties), a central line being put in, and the rapid treat of Acute coronary syndrome.

I've seen the incredible equality in the hospital between Jew and Arab, that initially surprised me and has now become totally irrelevent to every aspect of hospital life.

But the main learning experience of this week has been the incredible feeling of incompetency that I've developed.

I'm used to not knowing stuff. After all, that's why we come to University. But I'm not used to the look of horror on a Doctor's face. Unfortunately, that's exactly what I got.

It all started with a perfectly innocent question; 'Do you use thrombolysis for acute MI'; a rational question on the surface (for the lay folk - I was asking whether they use a clot-busting drug when treating heart attacks), but one that - apparently - overlooked the entire essence of cardiology, and made sweeping generalisations on the treatment of a whole range of different infarctions, each with its own treatment. I was sent away, tail between legs, to go and read up on myocardial infarction.

But that wasn't the end of it - as a result, my entire teaching experience has changed. Whenever a patient is admitted, rather than the productive (and easy) process of watching, asking questions on the things I don't follow / understand in Hebrew, and reading the patient summary, I'm now pretty much ignored until the end of the treatment process, whereupon Rita sits with me and criticises my lack of knowledge on a subject, stating that the level of my questioning isn't high enough; 'if I don't know the basic pathophysiology of complement cascade and its influence on coagulability, there's no point in knowing which treatment is best'.

I don't know what's to blame for the situation. My differential diagnosis is as follows.

1. Manchester University is crap. The teaching is nowhere near the standard of the Hebrew University of Jerusalem. I knew this already, but was unaware of the extent.

2. My doctor is a psychopath. She has bipolar mood swings, and despite her incredible medical knowledge, lacks the fluffy people-contact skills required by a doctor.

3. This is the Israeli way of encouraging learning. Softly softly isn't in the dictionary.

4. Rather than Manchester being crap, Hebrew University is exceptionally good. This is arguably true - I met Condoleeza Rice's cousin, Dr Phil Rice, who was over to discuss some research plans between Hebrew University and Harvard Medical School.

5. A combination of 1 and 4.

6. Any permutation of the above.

Anyway, the only saving graces of the week have been as follows.

1. I decided to be Israeli and spontaneously transfer Doctor. Things were much more encouraging when I shadowed other people, although I still know I have a shedload of work to do this year. That technique was fine til Rita tracked me down and kidnapped me for a grilling.

2. I'm very happy outside of work - meeting so many friends, old and new, including the people I took on tour here 2 years ago, and have now just arrived for their gap year here. Also meeting great people at the Absorption centre, from literally across the globe. Been to watch England football matches, Flight 93 at the cinema, eaten incredible burgers, and the Beer festival deserves it's own entry, coming up shortly...

3. I'm not the only useless person in the hospital; one of the interns, a Ukrainian immigrant who I shall call Vladimir for the fun of it, has less knowledge than me, not to mention a crap Hebrew accent. If he can work there, there's hope for me (although I don't particularly want to be the bald short man who everyone blames for everything).

I'm not sure where things are heading with the elective right now. I'm still content and happy to be here, but I'm hoping the situation resolves. I don't want to spend the rest of my time here feeling inadequate.