Cottage cheese has spawned a social protest and created this week's drama in Israel's press, politics, and business. In contrast, the general strike launched this past Tuesday by the Israel Medical Association garnered much less coverage. How is it possible that a society that has built a strong and excellent public health care system over many years is now protesting with such a muffled whimper- The strike affecting the health care system is causing serious harm to some patients, and may lead to further unpredictable long-term damage. The Israel Medial Association's leadership is particularly responsible and for many years has avoided using this striking tactic. The Finance Ministry also has an interest in ending the labor stoppages and preventing a system-wide strike. Well-timed media spins are driving the current negotiations, which must end with positive results, immediately. The excessive tumult about shortening interns' work hours to 18 must end. Medicine is the art of learning, and interns acquire proficiency through their continuous and systematic presence in a hospital. The proposal of an 18-hour shift - for which I have not found one supporter in the health care system - could undermine the medical profession and new doctors' training and professionalism. It may also damage doctor-patient relations and over time, it may even create a different type of doctor. I believe this proposal, if implemented, will significantly and unnecessarily increase expenses for the health care system. The field of medicine recruits our best people, and we must enable them to have a decent standard of living by increasing their salaries and decreasing their shifts within reason, and by providing them with high-level training. We must also allow them to practice medicine in accordance with the norms accepted in the Western world. Perhaps a different functional structure is in order - one that promises adequate expertise and a decent quality of life for doctors while providing patients with appropriate care that isn't hampered by the side effects of fatigue. For example, a 24-hour shift could be divided into two 12-hour units, or 16-hour and 8-hour units that include one hour of training. The negotiations were already in advanced stages when, for the first time in the country's history, the Health Ministry's policy disrupted the process. The struggle now on the table isn't just about money and budgets, but about the foundation of medicine in Israel, its future, its values, and the education and training of young doctors. In the history of doctors' strikes in Israel (1983, 1994, 2000), only the intervention of the prime minister, or neutral parties working on his behalf, brought about a proper solution. There is no point in waiting for a harsher strike and risking ongoing harm to patients and their families. We must join our society's best positive-thinking minds to bring an end to this strike. In the end, the struggle is about the nature and character of the health care system in Israel and the medical treatment provided to its citizens. The writer is chairman of the board, Assuta Medical Centers, and formerly director general of the Health Ministry.
