Elective in General Practice, Maccabi Family Practitioner Centre, Netanya

As a part of my elective I chose to spend three weeks at a general practice in Israel.  As I am hoping to move to Israel after I qualify, and am interested in pursuing general practice, I thought I could use this as an opportunity to get more familiar with the Israeli medical system and determine whether I could be comfortable working in Israel.

I chose the practice based on good reviews from British students who had done electives there previously.  It also had the advantage of being in Netanya, where I had access to a flat so that accommodation was free!

The practice is located in the centre of Netanya and has four doctors and a nurse on site.  It is associated with the Maccabi Health Fund, but is not controlled by them, so that private patients are also seen.

The population in Netanya is very diverse and includes a mixture of Israeli born, English, French, Russians, South Africans, Germans and several others.  The four doctors spoke at least six languages fluently and the practice had become so well known for this in Netanya that several holiday-makers had come specifically to the practice and waited for hours to see the doctor that spoke their native language.

I spent most of my time sitting in with a South African doctor who was fluent in English and Hebrew.  Approximately 40% of the patients he saw were English speakers. As my Hebrew was not very good, this mix was advantageous as I could easily understand a lot of the consultations and could improve my medical understanding as well as working on my Hebrew. Unfortunately, my level of Hebrew prevented me from being able to clerk patients before they were seen by the doctor unless they were English speakers, but by the end of the placement I could understand most of the Hebrew conversations as well and was starting to be able to speak more confidently as well.

The multitude of languages in the practice led to a rather unique challenge for the doctors as it was important for them to know in which language to greet the patient.  The practice was so busy that they rarely had time to look at a patient’s notes before they came in and, if they were greeted in the wrong language, the patient would immediately know that the doctor did not remember them, thus creating a breach in their relationship.

During my placement, I was most struck by the computerised system the doctors used to document their notes.  The Maccabi health fund has an internet-based system that can be accessed by any other Maccabi-associated-doctor in the city.  This meant that the doctors could simply write their notes from the consultation on to the system and this would then be accessible instantly to another doctor in the city.  This removed the need for referral letters as the doctors would simply give the patient a form to make an appointment with a specialist who would be able to look at the reason for the referral on the system.  This saved an enormous amount of time and was much more efficient than the UK system.  It meant that the doctors could send a patient for blood tests and chest x-rays and see the report as soon as they were available, allowing them to act promptly where necessary.

It was also interesting to note that, because the population is almost completely Jewish, in the week preceding Yom Kippur the doctors had to be slightly more wary than usual in prescribing drugs such as antibiotics as they were aware that most people would be fasting and inclined to miss pills.

Overall the experience was extremely valuable and I gained a huge amount of medical knowledge as well as very valuable information about the way medicine works in Israel.  It has given me a lot more confidence to consider working in Israel in the future.

Miriam Burns

King’s College London