As COVID sweeps across Israel, family doctors buckle under the load

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The strain hospitals are under due to the coronavirus has long been a major concern. But the virus has also pushed local family doctors to the brink of crisis.

In conversations with Haaretz, they said that calls from patients, some stemming from simple anxiety, have soared. Patient violence, mainly but not exclusively verbal, has also risen. In addition, doctors fear catching the virus themselves.

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“We’re exhausted,” one family doctor said. “The public is insanely worried, and we have to deal with it.”

Patients call about all kinds of things, from pain to palpitations, and “they want solutions now; nothing can wait,” she added.

In addition, remote medicine has led patients to contact their doctors more frequently, since doing so is now much easier. And aside from all their regular work, family doctors treat 98 percent of coronavirus patients.

A survey conducted in 2018, pre-pandemic, found that 58 percent of local family doctors thought their workload was too heavy, 44 percent considered their administrative tasks excessive, 14 percent were considering leaving their jobs and 12 percent had suffered verbal violence. Since the pandemic erupted, many say the situation has gotten even worse.

Dr. Yoav Yehezkeli, who previously worked as both a hospital deputy director and a district medical officer for health maintenance organizations but is now a family doctor, has devoted a lot of attention to burnout in the health system. He said one major problem is that doctors simply don’t have enough time to talk with and assess their patients properly.

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Visits are supposed to last 10 minutes each, he explained, and “two-thirds of that time is computer time. There’s not really time for eye contact with the patient.”

The competition over patients among Israel’s four HMOs has also contributed to the problem, since it led the organizations to expand the services they offer and demand that doctors be more available, including through digital apps and remote medicine.

The coronavirus accelerated these trends, while also creating new needs. There have been more telephone and video visits, in which “it’s impossible to examine the patient or make eye contact,” Yehezkeli said. “This lowers the quality of [treatment], and it’s also less rewarding for the doctor in terms of personal satisfaction.”

Moreover, said Dr. Shay Krontal, a family doctor from Kiryat Ono, there has been “a dramatic rise in the number of calls. People who would call us once a month now call three times a month, with requests that aren’t necessarily directly related to the coronavirus.”

Krontal, a member of the Israel Medical Association’s forum on physicians’ health and welfare, said doctors themselves are also more anxious, because they have “very high exposure” to coronavirus patients, “so our risk of getting infected is high.”

A clinic in southern Israel. Eliyahu Hershkovitz

He noted that he sometimes sees 30 patients a day or even more, and patients don’t just talk about medical issues. Doctors also hear about “concerns that something is dangerous” or “that something happened at home – a marital crisis or a death. And our ability to deal with this has shrunk a lot,” he said, because the doctors are “exhausted and worn out.”

A family doctor from the Sharon region said there has been “a very significant rise in patients’ anxiety and emotional needs, and in many cases, we’re the front line.” Lockdowns and other coronavirus restrictions resulted in many people losing their jobs and created a surge in domestic violence, and the result is “a lot of requests for medication,” she added.

Then there are patients who “don’t want to wear a mask and request an exemption from the doctor,” or who want an antibody test “but don’t meet the criteria,” she said.

But growing workloads and remote medicine aren’t their only complaints. Many doctors also complain about the frequent changes in Health Ministry regulations. It’s hard for doctors to keep on top of all these changes, and it’s also sometimes hard to justify the regulations to their patients.

A doctor from central Israel said patients “are losing it” due to the virus. “There are a lot of conflicts with patients. We fight over the fact that they need to come to the clinic with a mask even though they’re vaccinated… There’s a rise in violence – mainly verbal violence, but also physical.

“I worked in a clinic that was always very calm, but since the coronavirus started, the amount of yelling and cursing has risen greatly. We take it as much as we can, but many times, I’ve found myself telling a patient, ‘You can’t talk that way. Get out.'”

The doctor from the Sharon region said the expectation that doctors be constantly available for patients makes them feel that patients “don’t value your time as much.” Patients call “while they’re driving or in the bathroom.”

Ultimately, this comes “at the expense of our time with our children,” she said. “The family also pays the price, and that also contributes to burnout.”

In addition, she said, patients call about administrative issues, like forms, that aren’t related to medicine at all. Taken together, the situation has gotten so bad that some of her colleagues are considering quitting.

“I think one of the problems is that we don’t have a good enough support system, so family doctors are forced to do jobs that other staffers could do,” said Dr. Yael Gillerman, another family doctor. “The needs have changed greatly, but the number of workers remains the same.”

“We feel like a Lamborghini caught in a traffic jam,” she added. “We have the ability to do superb medicine, but we can’t. And this burden is ultimately rolled over onto the hospitals with greater intensity and with patients in worse condition.”

The Health Ministry said that dealing with the coronavirus over the last year and a half has been “a great challenge” for all medical staffers, but so far, they have stood up to it very well and provided excellent care. “Burnout among these staffers worries us, and to this end we’ve built a program that’s waiting for the necessary resources to be approved,” the ministry added.