Israel emergency medicine head advocates end to 24-hour shifts

A talk with Prof. Mike Drescher of the Israel Association of Emergency Medicine

By ALAN ROSENBAUM
Professor Mike Drescher, Chief of Emergency Medicine at Beilinson Hospital and chairman of the Israel Association of Emergency Medicine (photo credit: AVIV CHOFI)
Professor Mike Drescher, Chief of Emergency Medicine at Beilinson Hospital and chairman of the Israel Association of Emergency Medicine
(photo credit: AVIV CHOFI)
Prof. Mike Drescher, chief of emergency medicine at Beilinson Hospital and chairman of the Israel Association of Emergency Medicine (IAEM), expressed his support for the recent public demands by doctors in training to do away with 24-hour workdays in the hospital.
“Not all specialties are the same, but in the emergency department, there is no place for doctors working 24-hour shifts,” Drescher said. “We have long called for day and night shifts for doctors working in the Emergency Department. When a patient arrives with an emergency at 4 a.m., she should expect to see a doctor who is fresh and alert, not someone entering their 20th straight hour on the job.”
This will require additional resources, Drescher noted, but the return in public health will be worth the investment.
Drescher explained that his goal as chairman of the association was to ensure that hospital emergency departments throughout the country were fully staffed with both emergency medicine experts and trainees. “We are looking for people who are developing their entire career in emergency medicine. When you make that experience part of your practice, you are a better doctor,” he said.
Today, he said that most hospitals in Israel offer training programs for emergency medicine, but added that there are not enough training spots to staff all the positions that are needed now. Drescher pointed out that a well-staffed and organized emergency medicine program could distinguish between those patients who are very sick and need to be admitted and those who do not need to be hospitalized and can recuperate with follow-up outpatient care. 
“We have a ways to go in establishing emergency medicine as an institution in Israel in the way that it is in most of the Western world,” said Drescher. While emergency medicine has long been recognized as a medical sub-specialty throughout much of the world, it was only officially accepted in Israel some twenty years ago. “Once upon a time,” he said, “the emergency room was staffed by on-call doctors or junior doctors. It was a phase that doctors went through on their way to becoming specialists in something else. Over the years, it became clear that this was an area that needed a specialty.”
Drescher explained that hospital emergency medicine departments have become a major focus of care and diagnosis of COVID-19 patients. When the first wave of the illness began, emergency departments designated separate areas of each department to provide special focus and isolation. At that time, he notes, there was a general decrease in the number of people who came to hospitals for emergency treatment, due to concerns of infection from COVID-19 patients in the hospital. While the avoidance of going to the hospital for necessary emergency treatment was not healthy, it did give the emergency medicine departments time to organize and prepare for COVID-19 patients. Now that emergency room visits for non-COVID related ailments have returned to normal, however, emergency medicine departments are spread much thinner. He added that “dealing with suspected COVID-19 patient is more complicated – in terms of where to do x-rays and protecting staff. It adds another layer of complexity and complication and requires resources and attention.”
Today, explained Drescher, emergency departments in Israel treat approximately 3 million cases per year, and doctors who specialize in this area need to have vast familiarity with a broad base of medical knowledge, coupled with the ability to quickly make decisions under pressure. “There’s a huge amount to know, and you have to be prepared to take care of an enormously large range of problems. You have to be a well-rounded and very knowledgeable physician to start with,” Drescher said. “We don’t have appointments, and you never know the next thing that will come through,” he added.
Unlike family doctors who see their patients regularly, emergency medicine physicians usually do not see the same patients a second time. “There is no luxury of developing relationships over time, and your compassion quotient has to be high so that you can do that with someone you don’t know – someone who is different from you,” he said, adding that patients who come to hospital emergency rooms for treatment are frequently among the more marginal members of society, who may not have an organized family doctor.
Looking to the future of emergency medicine in Israel, Drescher said that more physicians were choosing to specialize in emergency medicine. “We are moving forward,” he said, “but we need to push to the point where it becomes the standard. As the head of the Israel Association of Emergency Medicine, we have a lot of work to do, and the public needs to know that we’re here for the public.”