Prescribing the Dream — Nation of Bests

I often joke with my family about my unique contribution to medicine in Israel. Since every physician I meet, or hear about, seems to be “hachi tov baaretz”, or the best in Israel, I fill a critical need. After all, since he or she is the best, there must be someone (read me) around who is not.

We in Israel, are a medical nation of bests. No, I don’t mean in the Chosen Nation sense. The theological underpinnings of medical chosenness gets stowed away in my ‘complete ignorance’ mental file. But when it comes to the practice of medicine, we are the best doctors around.

And this preeminence doesn’t only apply to the caregivers. Those of us outside of the medical field only get treated by the best physicians. And if we occasionally settle for the second best doctor around, it’s only because he was coronated by the best, who always happens to be my neighbor or the guy I sit next to in synagogue.

Back in the US, there are incredibly accomplished  academic and clinical physicians who were given salutatory epilations. Well published, experienced, perhaps even a medical pioneer or recognized leader in a certain field. But the best?

Here in Israel, it seems that every physician is the best, or at the very least, and pity these poor individuals and their mothers, a department head. By the way, next time you hear someone is a department head, gently ask just how many other physicians are part of that esteemed department.

So how is it that we, the chosen nation, became the chosen healers? Israeli medical schools are good, no doubt. So are the specialty training programs. We experience a disproportionately large number or rare diseases due to large concentrations of specific ethnic groups, and relative inbreeding within some of our more insulated populations. For example, Israel has an inordinately high number of BRCA gene-associated cancers, specifically breast cancer.

We also see more than our share of terrorism and war-related injuries, some of which require unique diagnostic and treatment strategies. In my field of interventional radiology, we rely heavily on x-ray technology to identify and treat potential sources of life-threatening hemorrhage. What happens when visualization is obscured by x-ray impenetrable shrapnel from a metallic object-laden explosive? This concern is not one, that most of my non-Israeli colleagues grapple with.

What is it about Israeli physicians that enables each individual to be the best. Perhaps it’s the highly selective process of obtaining acceptance into one of Israel’s very few medical schools? Perhaps it’s that ever present (translate oppressive) Jewish value of intellectual and academic achievement. One which leaves little room in the social strata for second best, by the way, leading to a disproportionate host of psychological pathologies in our tiny country of over-achievers.

Perhaps it’s a religious or ethical imperative to be the best at what we do. After all, what right do I have treating this human being in front of me, when the guy down the road can do it better. Or maybe it’s because we treat our enemies with professionalism and compassion, just as we do our own. Or perhaps we’re the best because we fly off to faraway lands hit by natural disasters, and become the first operational field hospitals for the affected populations.

Maybe it’s more pragmatic. Given the ever expanding field of medicine, and small number of Israeli physicians, there are in fact, quite a few open ‘best’ positions.

Despite our unreserved confidence in declaring others (or more likely ourselves) the best within a particular medical field, most will agree on the subjectivity of the term. Most experienced? Perhaps, just look at how many grey hairs I have. Best trained? Maybe, just ask me and others who trained at the same institution. Best looking? Definitely, just ask my mother.  But the very best?

It’s a well-known quip in the US that a doctor is evaluated by the three ‘A’s. Amicable, Available, and Able. And the ‘able’ part is the least important factor in determining patient satisfaction. But from the physician side and perhaps the patient side here in Israel, we still place a premium on the able component. I, for one, would be quite reluctant to counsel my patient that I have little knowledge or ability to treat them, but choose me anyway, because I’m a nice guy and available on weekends.

But my cynical spoil sporting about our nation of best physicians misses the broader point. To be the best is inherently Israeli. We are collectively and individually the best doctors, because we are a nation of bests. We are protected by the best military. Our children attend the best schools. We bring our cars to the best mechanic. And we only eat at the best falafel stand in town.

We may be convinced that we are the best as a necessary survival mechanism. Our military is the best, because we cannot afford to lose, even once, in this tough Middle Eastern neighborhood. We are the best engineers, lawyers, agriculturalists, finance executives, high tech professionals, and schnitzel fryers, because we are a tiny nation, still in its developmental infancy. We need to get it right, in order to develop into a healthy and mature nation. And we want it to be a place where we build the most passable roads, produce the most tasty cucumbers, and enjoy most delicious artery-clogging fried chicken breast (at least four times a week) for us and our children.

Or perhaps we need to be the best in order to maintain or improve the socioeconomic status of our families. We send our children to the best schools to give them the best chance of future success. We desire that our sons and daughters be the best, so that they will be matched with, and produce a next generation of bests.

We have the best students and transmitters of Jewish tradition, because that is what we have always been about, why we are here, and where we are headed. Out of Zion shall the Torah shine forth, is a privilege and national imperative.

I’d like to share a dirty little secret. How do we really become the best? We (and our mothers) repeat it enough times and to enough people, and voila, we’ve achieved greatness. Much more expedient than actual objective accomplishment. Actually, very few, if any, of us doctors here in Israel are the best around. Necessarily, some may be the best in Israel within a particular sub-field. At great risk to our individual and collective egos, however, we should recognize that we don’t actually have that much competition in our Israeli mini-medical universe.

But claiming to be the best sets a standard by which we must strive to live up to. And herein lies our Israeli uniqueness, if not our actual superiority. We are small and developmentally immature. But we are headed for greatness, because we are firmly rooted, yet constantly adapting, innovating, and growing.

Being the best is not a static achievement. It is a growth process, whether motivated by national necessity, ethical responsibility, or personal ambition. And every step forward, makes the light emanating from our unique nation flourishing in its land, shine that much brighter. And that is something, our mothers can sincerely brag to their friends about.

About the Author
Dr. Adam Farkas is a senior vascular and interventional radiologist, and director of the Vascular Anomalies Clinic of Jerusalem, at Shaare Zedek Medical Center. He has a special interest in vascular tumors and malformations in children, as well as non-surgical treatment of uterine fibroids. Adam is thrilled to be practicing medicine and living in the Jewish homeland. Adam make aliyah with his wife and children in 2012, and is a proud resident of Gush Etzion.
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