Lessons in Humanism – What Can We Learn from Israeli Healthcare
Humanism in medicine – so needed and so essential for quality healthcare. You know it when you see it. But what is it? The Arnold P. Gold Foundation “champions humanism in healthcare” which they define as “compassionate, collaborative, and scientifically excellent care” and states that healthcare “will be dramatically improved by placing the interests, values and dignity of all people at the core of teaching and practice.” Humanism in healthcare comprises kindness, safety, and trust.
Unfortunately, we have seen exemplars of a morally compromised breakdown of these principles in U.S. healthcare institutions over the past year. Protests of medical students and physicians with “Long live the intifada” heard outside patient rooms, claims that American Zionist doctors and nurses may harm patients, blacklists of Jewish mental health therapists, shouting at cancer hospitals, and antisemitic social media posts among medical students create divisive, even hostile work and learning environments, do not foster collaboration, and do not provide a welcoming and safe environment for patients.
Physicians must work with diverse colleagues from various disciplines as well as nursing and other allied health professionals. Our medical students and resident physicians in training need to learn how to care for patients regardless of politics or religious, ethnic background. Without a safe, kind relationship between fellow health care providers built on trust, patient care may be compromised. As a result, inquiries have been opened at two universities including medical schools and associated health centers.
Scientific advancement is also threatened by antisemitism creeping in to the field of medicine. The Federation of Israeli Medical Students was recently suspended from the International Federation of Medical Student Associations (of which the American Medical Student Association is a member). This harmful suspension prevents student exchanges and collaborations, and thus, shared learning. Calls for exclusion and boycott also reduce research funding and academic participation in professional conferences. Research collaborations are essential for discovery of knowledge, such as a recent study involving the pathophysiology of Alzheimer’s Disease made possible by Israeli and American universities working together.
Lessons from Israel’s Healthcare System
The antisemitism within healthcare threatens its humanism and compels me to share insights gained from years building relationships within and learning from the Israeli healthcare system. I have always been struck by the ethnically and religiously diverse healthcare teams working cooperatively to deliver compassionate care to diverse populations. Striking examples include treating trauma victims from the Syrian civil war, building field hospitals in Haiti, placing cochlear implants for deaf Palestinian children, and Save A Child’s Heart treating over 7000 children from 70 countries with congenital and rheumatic heart disease.
I have attended Israeli academic meetings in my area of expertise where Jews, Muslims, and Christians are all sharing scientific research, collaborating, and learning from each other. I have presented at Israeli medical centers to resident physicians, including Israeli Jews, Muslims, and Christians as well as resident physicians from Paraguay and Ethiopia who benefit from the training at Israeli medical institutions. My Department has also helped train Israeli resident physicians regardless of their background during collaborative exchanges. These examples of supportive and collaborative learning must remain the norm.
While in Israel with the American Healthcare Professionals and Friends for Medicine in Israel in February 2024, I observed how the Israeli healthcare system demonstrated its humanism even in the face of the devastating terrorist attack of October 7, 2023. To reduce division, hospital leaders brought their healthcare teams together, including Jews, Muslims, Christians, and Druze, with the message that “what happens outside these walls does not enter the hospital” and that there are no enemies in medicine. Arabs, including heads of departments, and Jews worked alongside each other in Israeli hospitals before October 7, and this did not change. We would see a Star of David, a Cross, and a hijab among patients and among nurses hovering at the nursing stations. All patients, including victims from October 7, were treated with compassionate care regardless of whether they were Jews, Muslims, Christians, or Bedouins. During one inpatient consult in which I participated with two Jewish doctors and two Arab speech-language pathologists, no one discussed politics or personal opinions but only how we could help the patient with a challenging medical problem.
I saw how caring for your colleagues was a necessary aspect of caring for patients. At Soroka University Medical Center, 676 casualties were treated while under repeated rocket attacks in the first 24 hours after the attack. A collaborative, team-oriented effort followed with night shift staff helping the day shift, other medical centers sent 28 nurses and 18 physicians to assist, and social workers established an information center to help desperate families find their loved ones. Day care centers were established to care for the hospital staff’s children. Resilience teams supported health care providers who were continually exposed to traumatic stress, suffering, distress, and grief. Applying and maintaining resilience, when your own family, colleagues, or friends were kidnapped, injured, or killed on October 7 and during the subsequent war, to focus on and care for patients is a remarkable example of humanism. Healthcare providers and staff across different backgrounds and religious lines also volunteered together outside the hospital to reinforce shared purpose.
Difficult or challenging situations could and did, however, arise. A health professional at a prominent children’s rehabilitation hospital known for its cultural competency focus described two events. During a conflict in years past, tension developed due to misinterpretation of images on Ramadan food boxes that were distributed to patients. The coordinator of cultural competency assessed, explained, and educated about the images which diffused tensions. After October 7, 2023, a patient’s mother played a Hamas video during an encounter with the treating provider. Conversations with the hospital director resulted in an understanding of what was appropriate with the goal to not offend and to remain focused on patient care, which did continue for this child. Setting a tone that the focus was the patient, despite potential differences in background and opinion, helped create a trusting environment despite significant challenges. To the staff, hospital directors provided clear instruction on acceptable speech and behavior and what was not (i.e., civil discourse). When needed, disciplinary actions did occur.
For U.S. healthcare professionals, the Israeli healthcare system’s ability to focus on its mission of providing compassionate care by Jewish, Muslim, Christian, and Druze healthcare providers to Jewish, Muslim, Christian, and Druze patients and its attempts to keep politics from entering the hospital, even in such dire circumstances, serves as an important lesson in humanism. I observed how dignity of the patient regardless of background or religion was upheld. Health care providers showed empathy for the patients and for each other to enable mutual trust, and thus, were able to provide safe, collaborative patient care. These observations align with a recent 4E’s framework of Education, Engagement, Empathy, and Enforcement proposed to foster moral responsibility, combat hate, and promote an inclusive environment aimed at “humanistic, non-biased care.” I encourage our medical and other health professions schools and healthcare facilities to do the same.