מלי קושא בראיון על על חמלה ושיתוף מטופלים בכנסים רפואיים

מלי קושא, משנה ליו"ר החברה הישראלית לאיכות ברפואה ומי שכיהנה במגוון תפקידים בכירים בקופות החולים מספרת בפרק זה על ההחלטה לשתף מטופלים באופן אקטיבי בכנס השנתי של החברה הישראלית לאיכות ברפואה, וכיצד חמלה היא אחד המניעים החשובים שיש לשים במרכז העשייה הרפואית.

הפרק הזה הוקלט בחול המועד סוכות, ממש רגע לפני בטבח ב-7.10 ולכן יש לשמוע אותו בפרספקטיבה הזו מבחינת האווירה והדיון. האזנה פורה

Episode Transcript

(00:00):
The next episode, which you will hear, was recorded by me and Eliyat Melamed before the war.
Therefore, there may be jokes or statements that you will hear now that are
strange or not relevant, but in any case, we thought that this episode,
which deals with medicine, medicine,
and so on, the issue of patient-treatment cooperation in clinics, is worth considering.

(00:21):
Thank you for the invitation to participate in this episode,
and I'm happy that we have to go back and listen to the recordings,
and to go back and record and send you information about patient cooperation
in the health system. Have a nice evening.
You are watching the Podcast Participation. Everything important to know about

(00:42):
patient cooperation in the health system.
Good evening, Uri Goren. Good evening, Leah. You are teaching.
We are here in Sukkot, so welcome.
Welcome, welcome. Adim Nesimcha. I'm sure we'll share and there won't be any
jokes, but it doesn't matter.
You know, you have context. What are we investing to record this podcast? Absolutely.

(01:04):
And today, we have an interesting program that deals with one of the issues
that I like to talk about.
And that's the issue of patient cooperation in medical clinics.
You're going to tell me one of the issues that we're always I like to deal with
it and I want, as a reference to the fact that we have a special organization,
to tell a story about it. The issue,

(01:28):
Nothing about us, without us.

(01:55):
Patients Included. And this badge is given to medical nurses who decided to
help patients seriously. What is seriously?
Not just a crowd, not just a party, but on the stage. Let's talk about the fact
that even a crowd is not always... Right.
So the crowd is the first step, but really on the stage, as if they're talking,
as if they're partners in the content.
And there weren't many nurses who received this.

(02:17):
In Israel, when I was... When I'm talking about this, and I've been talking
about this for a long time already, my classic example Israelite l'Echo de la Réforma.
C'est une société incroyable parce qu'elle est une société multidisciplinaire
et Betty s'occupe d'un monde très important de l'Echo de la Réforma qui,
en soi, a aussi qui n'était pas suffisante dans l'agenda.

(02:39):
Nous parlons aussi un peu de l'Echo de la Réforma car nous parlons de ce kénos
que nous avons demandé à Malik Kousha.
Il a pris beaucoup de temps avant qu'il nous présente Malik.
Il a fait un build-up très réciproque.
I gave him a build-up member, right?
I've been there for about 16 years. We said, what, you're going to introduce yourself?

(03:01):
Because she really has a lot of strengths, and we don't want to forget any of
them. So what's your request, please?
So good evening, and I'm happy to be here.
So hello, Lachliya, hello, Uri. Hello.
And yes, we left everything at Sukkot, and we got to a podcast that, in our souls, Really?
The cooperation of the patients, and if the cooperation of the poor patients,

(03:23):
for us, in the Israeli society, to be a doctor, it was clear that it had to be part of it. So who am I?
I've been in the health world for 39 years. Wow, you're not going to the leg.
I'm in 32 general health services, and seven years in the unit.
The last two jobs I was managing the emergency network and the public health

(03:47):
center in the unit group.
And before that I was the main sister of the unit.
Thank you.

(04:18):
So we're probably going to have surprises from there as well. Exactly. Absolutely.
So let's have Desapri tell us, we said that... Wait, let's talk,
what is the Israeli society for medical excellence? What is the agenda of the society?
Our goal is to promote excellence and security in the health system in Israel.

(04:39):
The society is a multidisciplinary society, under medical arrangements, And basically,
we also plan procedures and also give them a stage in the year-long conference framework.
So we had issues during the year, we had one year that we dedicated to the issue

(05:03):
of the patient in the center.
A year that we dedicated the whole year to a treatment routine,
and then the treatments for the treatment routine came out.
And we worked on a treatment process for cancer patients which was my responsibility
to lead this group to develop a institutional program for treatment process for cancer patients.
Our goal is to promote

(05:25):
quality in all health institutions and not to rely on the old ways and to make
a permanent improvement and to bring everyone to quality business and the last
conference was the proof that it was happening in a meteoric way.
930 volunteers attended the conference. Wow.

(05:48):
We were very surprised, and it just warms the heart to see the glory of the
existing quality of business.
It's less than the number of participants, right? There are over 1,000 participants.
It's one of those places where the first plenary is beyond the standing.
אי אפשר, פשוט אין מקום להיכנס וכל פעם, כאילו, אתה אומר אוקיי,

(06:11):
אין כאילו מקום להכיל את זה כבר בישראל, לדעת,
So that's it. It was sold out very quickly. And we opened another event where
they could watch the event in the hall. Wow.
So we had 1,400 participants, which warmed the heart.
89 lectures, 17 lectures in the hall, and 262 e-posters.

(06:33):
Wow. And what warms the heart the most is to see the wide public presenting in these conferences.
It's a very important event. You can't talk about the patient at the center
without putting him at the center. You can, of course.
I think we're seven minutes into the podcast and we're done.
That's what we wanted you to tell me. After that, everything's fine.

(06:56):
So I want to, you said earlier, we just mentioned the conference,
and you said it was clear to us. But it's not that clear. When you talk,
you've been working for 16 years.
I've been working for 16 years. It was before me. It's really not clear.
But the patients weren't before you.

(07:41):
No, no, no. very unique, because it's not just that you invite everyone who
just wants to participate in the conference and see, you also allow patients,
you said posters and studies and so on, you allow everyone who wants to and so on, to enter.
How in general did it start? How did you get to this? I mean,
in a world that is very different.

(08:03):
For us, as a team, it was very clear, it's no secret, I, ten years ago, I had cancer,
I felt the side of the patient as well, and I tried to advance the subject of
the patient in the center, all the directions, and it was clear to us,
both for me and for my colleagues in the company.

(08:24):
I'm a little credit, because you have a few colleagues like that. Yes.
First of all, when Professor Rand Balitzer joined the Kior society,
the Israeli Society for Medical Excellence, the society received a completely specific response.
And we basically said, we...
We want to put the patient in the center and act according to the patient's needs and preferences.

(08:48):
And we need to influence the system to actually listen to the patient's needs and preferences.
And also, when we build some kind of strategy, we need to listen to his voice.
And not to the voice we think is his voice. Exactly.
And it's critical. Because what we think is not what the patient needs.

(09:12):
And there are also studies on this. There are studies that asked the soldiers
if they feel they gave the treatment according to the needs and recommendations,
and how much medicine was there, and asked the patients.
There was no connection between the two things. It's not surprising,
because we're here. And that means that if we don't listen and don't put our

(09:35):
voice in the center, then we're not, we're not, we're not aiming for the goal.
And we've also succeeded in improving processes thanks to the voice of the patients.
Give us an example, and after that I'd also like to hear if when you became
a patient, and cancer is a patient, a patient is not on the way to severe pain,

(09:55):
would you also have some kind of understanding of things that you were sure
I'm sure you listen to patients, and suddenly you understand something else.
Absolutely, absolutely, absolutely.
I'll give an example from what we all want to happen to the general public,
to introduce some kind of budget, that would want to change something in the

(10:16):
process that happens in the health system.
We got an offer on the subject of a quiet birth. Okay. Wow.
And it was a girl who had two quiet children. Wow.
And she broke the story of how much, also during the process of the murder of
the mother, and also later when she returned home.

(10:39):
In fact, she didn't get any support, not from the hospital and not from the
community, and she remained alone in this story. It's in a moment that is very,
very hard and can also affect the future health from the point of view of depression.
It's crazy. I heard a little bit about it.
There are places where women pass through a small room and then pass through
a children's room. Right.

(11:00):
And then, not only are they alone, they are also exposed to loss and trauma
on an hourly basis. Like, they see what they are losing all the time.
It's like, wow, it sounds to me like an unbearable nightmare.
I don't know.

(11:45):
Which helped us to adapt to this stage that they are not used to.
Right. With a different language, the audience they talk to is different.
Not to mention 1,400 participants, that's ridiculous.
And actually, I also took her, in the case of a single-person patient, so it was easier for me.

(12:06):
So I set up a strategic committee within the group, and I told her,
you're part of the team that is now changing processes within the group. Wow.
And I sat with you, I said, yes, you sit with us.
And basically we turned it into a central cause, and we built questions to understand
what the needs are, and she went and checked with 2,000 women who have a group on a social network,

(12:33):
and asked them what their needs are from the soldiers in the hospital and in the community.
I said, come with the results, and actually present not only your voice,
but the voice of the entire community, what its needs are, from the teams in
the hospitals and in the community.
And so, basically, the whole health system listens to these needs,

(12:56):
and we can change the rules within the system.
It's different from when we were quiet. I just want to point out,
we're pretty shocked by what was said.
No, I want to go a second back, because we took it as a matter of course,
and said it was clear to us that we needed to put a patient on the center.
First, I don't believe it. I'm sorry to say this. It might be clear to you.
But it's certain that it didn't go too far.

(13:17):
Someone said, guys, it's a respectable medical school. We're engaged in research,
in jobs, in medical quality.
What... What are you putting on a woman who has passed two years of school?
What will a person get, excuse me, a Mandehum from some organization and she
will teach me about medical quality?
So I want to tell you that once again, I'm going back to the time when we actually
went through a phase the moment Professor Rand came to the table, managing the society.

(13:41):
And basically we all joined as a relatively new team to the society,
it was clear to all of us that we need to put the drug in the center and we
need to change it within the system.
And how do you see the effect of this? Because, let's say, we talked about this
a little before we got together.
We said, okay, the company's conference is really contributing.

(14:04):
I just want to point out to everyone, it's not just the tax relief.
There are also many times shared chairmen, one of whom is a doctor and one is a doctor for years.
And last year there was even someone who is also a doctor, who was part of the
management committee of this thing.
That is, for the entire duration of the, let's call it, the expansion period.

(14:54):
Mets are part of the team. אתם יושבים, וגם עוברים לא מעט כנסים אחרים,
ואתם יודעים שזה לא העולם.
בעולם האמיתי לא בעולם האמיתי, מחוץ לכנס הזה, כמות השיתוף, או שיתוף כזה עמוק, מתרחש פחות.
אנחנו, דיברנו על זה שהיום אפילו יש עדיין מקומות, שבתור שעמותות,
אני אפילו לא מדברת על קהל רחב, מטופלים,

(15:16):
מהרחוב נקרא להם, לא מוזמנות, או לא אף אחד לא מוכן שהם יישבו בחדר כדי לשמוע את ההרצאות.
This is the world we still live in.
There is development. We are not where we were. We see the development still
far away. I agree that it is still far away.
But we are passing through this phase. We are still in places,

(15:39):
both at the private level and beyond the medical decision about the patient.
Do you invite him to this meeting?
With the team? Or not? We had a part on that.
I will tell you that I think I think

(15:59):
it should be that it can be that it can't because sometimes you have to say
things that are not pleasant and you have to know how to communicate them because
it's a different discussion so it can't be that it can't it's in line with the
needs and preferences of the patient if the patient asks for it,
you have to allow it right,
but you also have to do an observation of what you're going to hear but you're
not giving him the option no, no, no, I'm saying I agree with you,

(16:23):
you just have to do an observation.
But as a caregiver, when the caregiver sits next to you, you actually transfer
the information to the level he wants to hear.

(16:43):
What are you talking about in a utopian world?
No, no, I agree with you. This is exactly what I expect to happen.
What I expect to happen I agree with you I can tell you that not one I am invited
to lectures in front of oncologists, surgeons,
troops that are supposed to also spread the word and also to have a team discussion

(17:07):
and there are among them those who say no and there are those who have already entered,
the route that the patient is in the team and actually the treatment decision,
metkabelet yachad yim hametupal.
I want to... I'll do a rephrasing for a moment. No, so wait.
Can I ask a question first? Yes.

(17:27):
You say these things, do you feel that the fact that you did this in the Society for Medical Quality,
that this is a huge step for so many participants every year,
do you see it as a change even in other places?
I see, I totally see the change.
I see the change because enough that each one of us comes from another organization,

(17:53):
and it's something that comes out of us so it also flows into those organizations
and slowly we see the benefits of it.
There's something that impressed him especially, let's say, that he saw a change in such a benefit?
So take the issue of the quiet life Noal, Ministry of Health wrote after it. Because of that.

(18:13):
We wrote Noal in a unit because of this event.
Because of someone who appeared and asked to present. Yes, but the stage gives
It gives you confidence and so much strength.
No, I said it as something that starts from the patient. From the assessment,
not the effect. It all starts from the patient.
If it were, and you should see, when she was shown in the world,

(18:33):
people stood up and suddenly,
stood up and exposed the traumas that in the world the soldiers experienced
themselves and there was no one to support them. Wow.
Amazing. I was in this world. Really? That's what I wanted to say.

(18:53):
I think that when medical people come to a conference, and some of the nurses,
are hospitalized, and suddenly they hear people's voices, suddenly they hear
about amazing projects that the hospitals are doing, they're exposed to the
world that maybe they're not exposed to in their own space.
Some of them are, some of them aren't. It's not one-to-one.
But I want to go back to the subject of the staff discussion,

(19:14):
and the nurse, sorry, I'm stuck in this. So let me tell you about the staff
discussion. I understand.
I'm telling you, okay, I want to join the debate.
And at the same time, I personally dealt with the oncology field.
The answer I received, you're not proud of us.
Proud, but she wants to hear it. It was in 2013. Yes.

(19:38):
But I want to separate, what I wanted to separate, we went through a little
bit. Did you sit in the debate? At the end?
I didn't sit, but the decision didn't happen without me, because I said,
I want the whole picture, and I got the right decision. But that's exactly what
I wanted to say. There's a matter of doing the team discussion,
in order to change clinical opinions, blah, blah, blah.

(19:59):
No, blah, blah, it's important. To look at it, to discuss it,
and to finally decide the treatment decision, which is another situation that
needs to be done with the patient.
I'm saying that in a team discussion that is changed, it's not certain that
the patient needs to be part of it, so that it's a bit like putting a camera

(20:20):
in for a discussion. No, you can choose to do two discussions.
And then there's the discussion, what's called the go-to of the doctor,
the therapist, and the patient.
They talk about what are the options, and they decide what's going on.
And then he brings the... Uri, but we both know that it's not like that.
Uri, the perception, it's not, let's share the patients. Exactly.

(20:42):
The perception... But that's what's happening. But this perception needs to change.
It's not, let's share the patients, it's my body. And it's my body.
It's my decision on my body.
Whoever decides to share the medical staff on what I experience, it's me.
And we need to base ourselves on what I experience.
And based on that, we need to make decisions.

(21:03):
And not the other way around. And it's okay to... I'm trying to expose things
I didn't want to, but I have to right now. Talk.
Because I'm working now at the hospital, and in the last few months,
I'm working on some kind of health episode.
No, I didn't get into it. I went through the episode. Now, because you're the
person, you're enjoying the approach to the back of the rules of the process,
which I have to say that you don't always enjoy it. Right?

(21:26):
Anyway, I'll give you an example. Standing for a moment in a discussion of a
few radiologists, and the doctor who helped me manage the situation,
and it doesn't look good to me, and it does look good to me,
and it's here, and it's like this, and maybe it's this, and maybe it's this,
and they start throwing all kinds of names of diseases and all kinds of things.
Boi, this is a situation that I want to be told later on what they saw.

(21:47):
But I would love for them to scream their lungs out without me being there.
But that's my goal. Because all kinds of voices are coming. No,
because all kinds of things are coming.
Let's separate. I need to take a break. They can sit and hold a preliminary
discussion. And lose sight of things.
But to come to you with all the possibilities. To decide where to go.

(22:09):
And in the end, I, despite my approach, I went and I went outside the hospital
for a second because I wanted to hear another opinion and in the end I got it
to the place that I thought was right from the options that came up and you
can get it because you had all the information but I didn't need the back of the pen I,
in my opinion, this debate is a kind of back of the pen after that will be the

(22:31):
debate where the decisions are made do you know why it's a kind of back of the pen?
Because the team also needs to learn how to manage speech when the patient is in the room.
And that's a skill that needs to be mastered.
Completely. Right. It could be that the reason you were so stressed is because
they ran over your head and you're not a person who doesn't understand at all. No, on the contrary.

(22:53):
Because I don't know that I understand. I assume that it also happened as a
personal issue that sometimes you assume that you understand but forget that
when you say it about yourself, it's like there's another effect when you say
it about someone else. By the way, either yes or no.
I'm not sure it's a personal effect. Not a personal effect, the effect,
the fact that you're saying, a growth in the number of this and this and this,

(23:15):
with a prognosis of this and this, it's something you're saying to someone else,
and it's something else when you're saying it to yourself.
You're right, but here... That's why the skin needs to know who's sitting in
front of it, and to feel what the patient really asks, and also what he doesn't
ask, or what he doesn't want to know.
And I'm saying it's a skill that needs to be learned. And until you're not sure.

(23:41):
כל הצוות שיכולים לנהל שיחה כזאת עם המטופל שלא יעשו אותה.
זה יגרום, כידוע לך, Uri, יותר נזק מתועל.
לא, זה מה שאני מנסה להגיד. אני אומר, לא אכפת לי שהתנהל איזה מין שיח חסר מעצורים,
נקרא לו, במרכאות כפולות כפולות, ואחר כך, בסוף, החלטה טיפולית היא חלק מצוות טיפולי שהמטופל נמצא בתוכו.

(24:04):
אבל כשאני מסער את מוחותיי לדרך, זה כמו שאני, כמו שאת בחינה הרצאה to a support
team. There's this discussion that's so-called ridiculous, and then,
okay, from there, some direction or some directions are being crossed.
I don't see any problem with that.
Those who sit in a support team and raise ideas about what this is and why this
is, and in the end, they come, they ask the patient what they know about the situation.

(24:26):
It's the definition of the meeting, of the team. I think we agree,
it's the matter of semantics.
So, let's go back to the conference? No, no. I think it's interesting because
it's also related to this discussion of, it's exactly, the discussion The argument
I'm making now is part of the argument of those who say, in professional meetings,
I don't want to start thinking,
wait a minute, maybe there's a patient in the room that it affects the situation.

(24:47):
I heard a lot of things, and to me it's like, you know, I get sick every time I hear it.
Starting from the fact that we can't talk next to patients in the room,
we're capable of exposing medical information.
I didn't really understand how it happens, so don't expose names, don't expose this one.
I've already heard someone say, we speak a lot in English, and they won't understand us.

(25:12):
I don't know, most of the citizens of Israel speak English fluently.
And if they don't, they have to deal with it.
There are all kinds of axioms like this that are very interesting for me to hear.
Because of this, I asked you, how did the medical institution respond to this decision?
You say it like it was clear to us, to you, yes, but to those 1,400 people who

(25:34):
are in most medical teams... It was a surprise. It was a surprise.
It's not something that they're used to. How do you put in people who are not
from the field, not from the field, to hear professional content,
and more than that, to listen and be in the same mood that one presents a study

(25:58):
and she presents a process that she has experienced and all the truths that
have been told about the silent births and she basically shouts,
let's change the system.
Yes, which is in general... Look, but... To come and put such a thing in a conference is not simple.
In a conference that the Israeli society has held, everyone sits,
I think most, if not all, the hospital managers, usually,

(26:22):
most, if not all, the hospital managers, the director of the Ministry of Health,
the Minister of Health, That is to say, the entire decision-making elite of
the Ministry of Health is sitting in these rooms. All the candidates.
Right? All the candidates. You're saying if it's not there, then where?
No, so when something happens there, the message that comes out of such a conference
is a message that directs to the decision-making tables in the system.

(26:45):
And yet, we see that the change, we're talking about 10 years or so,
that this thing is happening, that the change is not as significant as we had expected.
I mean, if I were to expect that if there are a lot of medical staff standing
there and wearing all the masks and so on and so on, and you see a woman like
that standing there and speaking the words of the people, and saying,

(27:06):
here, this is how you can change the, the same complicated journey to make me healthier,
in the end, and don't want to go after it and exploit it for about 70 areas
or 700 other areas, then maybe we failed, maybe it's not...
I'll go back to your previous question, how did the fact that I left affect

(27:27):
my business? Interesting.
כל תהליך אסטרטגי שהבננו, היה שם שיתוף מטופלים.
אם היינו צריכים לבנות תורה לטיפול באזרחים הוותיקים,
עשינו קבוצות מיקוד בקרב האזרחים הוותיקים ובקרב המטפלים העיקרים בני המשפחה שלהם,

(27:52):
בשביל להבין מה הצרכים האמיתיים שלהם.
לא בנינו שום תורה ושום תוכנית אסטרטגית בלי לעשות קבוצות מיקוד או סקר בקרב אותו
קהל יד כי אנחנו צריכים להתבסס על זה.
והם יושבו אחר כך גם בוועדות למשל.

(28:12):
לגמרי. זה משהו שאיפשרו לך? לגמרי. ולא הרימו גבה? עכשיו, שוב,
אני הייתי בעמדה בחירה. אז היה לך יותר קל.
זו החלטה שלי. אז היה לי יותר קל. אבל זה מחלחל, כי כשמישה בעמדה בחירה עושה את זה,
אז אחר כך מישה בעמדה פחות בחירה יכולה I want to see more of that.

(28:59):
To say this in the presentations.
Workers, workers, workers, workers, and in the end something that is not at
all related to the needs of the patient, but maybe to the needs of us as an
organization, or what we thought were the needs of the patient. It's very, very far.
So give us maybe an example of things like this, that suddenly you saw the significant change.
You thought, A, and actually you needed B.
If I take one, let's take the example of the old citizens.

(29:25):
The time that needs to be allocated to them.
Okay. Okay.

(29:46):
It's something automatic. You go, get surgery from the sister,
so there's a living room.
Not when you go in and you have a room and you sit alone with your sister,
who actually takes the anamnesis and checks the patient.
There are stands inside the big room. And we said, wait, it can't go on like this.

(30:07):
So it's a need that came from the patients? From the patients.
Okay. And you thought before that it was okay? It's not... זה מה שהיה מקובל.
זאת הייתה המסורת.
וגם בבנייה של המרפאות החדשות, הם כבר נבנו אחרת.
שמה, שיש בהם בעצם חדרים שמאפשרים יותר פרטיות.

(30:30):
כמעט כי אזרחים ותיקים וחולים כרונים, יותר קשה להם להיפתח.
אני חושבת שאפשר סיים.
לא, אני חושב שזה מהמם. אני גם חושב שזה מעניין, כי זה נורא קשור באמת לאיכות ברפואה.
זאת אומרת, בסוף, כשאתה נענה לצרכים האלה, בסוף אני מניח שגם איכות הטיפול עולה.
כי אם המטופל מרגיש יותר בנוח, יכול להיות שהוא מוסר יותר מידע שחלקו חיוני לטיפול.

(30:56):
חיוני לטיפול. ואולי הוא הסתיר אותו קודם, וזה פגע בטיפול שלו,
רק בגלל שהוא התבייש, והוא הרגיש שאולי, מרפאות זה עניין קהילתי.
זה יכולה להיות השכנה מימול.
I'll give you an extreme example, but today, someone who comes to the animal
hospital, or to women, the animals are supposed to ask her, what's going on

(31:20):
at home, is everything okay, do you need anything?
Now, think of a big room, full of people, there's no way she'll answer the real
question, even if she needs help at home. It's all fine.
Yes, exactly. The chances are that she'll answer, it's in a closed room,
but you definitely increase the possibility. Now, how much does it change her
health? Very much. Right?

(31:40):
It's exactly the story. Even in building a hospital for disabled women that
we did in the unit, so also, according to the needs that arose,
the services were built. And most of the services turned into hybrid.
Because they wanted less to get to... Yes, she wants to continue working.
She wants to get the service from wherever she is.

(32:02):
And that's how it was. And in fact, the hybrid services developed Yitpatchu od lefne, droma korona.
Ki ze masho se tsamach mitoch masahot hametopalim.
Aho tshum nakum velelechet. Zew, sagart et apot, az perik acharon.
Olam otopi. Tiro, yesh od harbet.

(32:22):
Yesh yam. Pshut yam. Gam kshe avarti le diur mugan.
Asta misakel. Ata umer, ma benzam tzarech? Yachas ishi?
שיחה בגובה עיניים מישהו ש יראה אותו והסתכל בצורה אנושית, חומלת,

(32:46):
and take care of his family's well-being, and actually develop services around
this thing. By the way, health.
At the end of the day, such a person will be healthier for years to come. And check if...
Come on, we celebrated there more than 100.
Because there's a community, because there's meaning, because there's quality,

(33:08):
because there's daily physical activity, and you take care of your health.
There's this series here, in 1984. and four? Yes.
It's amazing how a little non-economic hand-washing suddenly takes people out
and moves them and suddenly prevents them from the wheels. It's a shame. It's a shame.

(33:30):
So why actually, if it's... But it connects, because do you think it's related to the earthquake?
It's also related to the earthquake. So let's just... That was exactly my next question.
If we're sitting here and say, I can close the podcast, the world is wonderful,
this is the health system.
And it's clear to us that it's not. Why is it not?
Everyone understands, or almost everyone, most of the medical teams already

(33:54):
understand that something needs to change.
Some also take steps in this direction.
But it's usually too little, and too hard, and not enough flavor,
and not with real patient cooperation.
Why is it not successful? Why is it not something that has become l'yot barur me'alav b'shnat 2023?

(34:14):
I believe that the change must come from the top.
That is, it is something that must, and I do want to touch on the issue of human
rights, because I think that it must take this value,
because this value is significant also for management of an organization.

(34:49):
But it's only this or is it also a matter of budgets and of facilities?
Look, we're in a time when budgets are always short, always short,
the costs are always high, and they've grown.
There's a shortage. You can't ignore that.
There's a shortage of human power. On the other hand, there's also a shortage of equipment.

(35:11):
Even when they've already opened and added lines, there are places where there's
a shortage of equipment, because we've returned the budgets.
But it still allows the smile, what you say, you need 40 seconds in a meeting with the patient.

(35:32):
And this is a skill that needs to be learned, to train the soldiers more in
medical schools, in medical schools, in health services, and it's something
that the management, the choice in every institution,
needs to understand.
We need to act according to values and not to act according to goals in those

(35:56):
days when everything was exactly the opposite no,
but the humility even if you humiliate the team you humiliate the team on his
weaknesses so he can the pressure is much higher,
and there is a place to humiliate someone else because if they don't humiliate
me at all and I will be quiet here until the end,

(36:18):
it is very, very difficult for me to create a sense of security towards a patient.
So, that's what I'm saying. Like, there is no security for a patient without
a security for the caregiver.
The question is not two lines, let's call it that, or two lines that are tied.
Because, in the end, I completely agree. I also really think that there is a
lack of security towards the medical staff.

(36:40):
Also, by the way, from the side of the patients, sometimes questions that come
to the emergency room a mousse, or a part of a mousse, and they don't understand
that there are people who physically
run from their legs because they were turned on, I have no other way.
Yes, but the patient comes sick, you can't But in the end, it's a side way.
We can't come and tell the patient, you need to be a part of it,

(37:04):
and completely remove the responsibility.
I think there is responsibility here, but I will put it on the side.
So there is this side of the chameleon, but there is also the other side,
that in the end Shabbat Shalom.

(37:36):
And then we'll ask the question, did you say earlier, the quid quid? I very much agree.
I think there's some kind of constant rush after more air and water,
instead of a moment of silence, to think, let's see how our health system looks
like and how it should look like in other ways.
Which is maybe what we so love about the Knesset. Yes, that was even the last

(37:57):
agenda for you, how do we re-establish the health system in a changing world?
Because our world is changing.
We're in a time when technology A new technology is being developed in a meteoric
rate that has many advantages, but it is also a bit dangerous.
And we need to see how we, as a quality company, do the necessary quality check
on all the processes that are taking place and put standards into this.

(38:21):
And this thing, the chat GPT that came in and actually changed...
We have a chapter on this as well.
Changed everything, and things are already going and being done automatically.
And children who started learning
this year, they're already living in a completely different world. Yes.

(38:41):
These things specifically strengthen the fact that we need to encourage even
more the issue of humanity.
You see, this subject is studied and the whole world is busy with the issue
of gender equality, which is actually what will make the impact significant.
If in the years 2000 there were 50 studies, in 2021 there will be 1400 studies

(39:04):
that will deal with the issue of gender equality.
And actually, if we close the studies, we see that it improves the balance of
the team. If we have a government that supports the value of humanity for the
military, then the pressure on the military is much higher.
And in terms of the clinical results for the patients, it's less complications,

(39:27):
less symptoms for the patients, the moment this value...
In fact, it is found in every therapist, and it's not just a doctor or a nurse
or a social worker, it also gives a service in the DLPAC that needs to bring
the level 17, or to assist him and be his GPS.
Sometimes it's more important than anything else, because it's the most important

(39:50):
thing for the patient, especially the last patient, who are directing him in all directions.
That is, if we support the value of humanity towards all providers of services,
around all providers of services,
The results will be much higher, and more than that, what we see in the studies,
there are fewer symptoms of the patients, a much higher degree of depression,

(40:11):
and better clinical results.
That is to say, we need to pass a phase, to enter the community and society.
I bought it. And we also started, we established a working group on this subject,
together with your forum, Dr.
Berlovitch, and a claim that she won in the project of the BFK.

(40:33):
Bidiou, when she won as the leading health minister for the year 2022, and not alone.
We at the Rafa'a Association are organizing all the work that also comes to the Rafa'a.
It was clear to us at first that this is the issue that needs to be addressed.
Because we want to support the issue of health and humanity.

(40:54):
And I am now leading the team to advance this issue.
And we sent a letter to the head of the Ministry of Health that we want to advance
and break the limits and break the barriers to the promotion of humanity in
the health system because that's what will make the change,
Amen. Really? No, really amen, because I think you're right.

(41:15):
I'm getting optimistic, by the way, from all this conversation.
I think it's very interesting. I also think that humanity has something in it,
it actually brings the mutual understanding.
It brings the mutual understanding, and therefore it brings another language
between a caregiver and a patient, and then all the things happen.

(41:36):
You see a patient as a person, and not as a number of the calendar. No, no.
Yes, I'm not just looking at it. You see the person that he's in love with. You can also.
Understand it or give him that place. You see the person always,

(41:57):
but it gives a different angle to this thing.
I don't know how to explain it. You're bringing me back to the years when I was Asakti,
defnei shloshim shana, kshayiti yachot onkologit, vayu mufnim elayim mitupalim,
shlo etzikhu la'azen otam mebkhinat kevim.

(42:18):
Azani olakht lebikru ba'it, vaylo eshkach, ani yoshevet, vayni makshiva. Hikshavti.
Vyemtupalit eta megia vavrat kol harofim haefsharim, vaylo etzikhu la'azen otam.
What was her pain in the end?
That she and her daughter were diagnosed together after a year of being sick

(42:42):
and received chemotherapy together.
That was her pain. Her pain was mental.
No medicine will help her there. She just needs to listen.
So we went to the social worker, a little bit of ventilation for her feelings,
and that's what made her feel better.
That is, we're in a rush, right? There's no time.
Right, there's only five minutes, but you're not alone. Arufel not alone, there's another team.

(43:06):
And if we as a team and we can activate in any place a team work so that everyone,
in fact, the patient's vision, and can later in a team discussion,
in fact, share in some angle how to build a treatment program for chronic disease
together, it's different.
Such that it's adapted to his resources, to his supporting environment.

(43:28):
To his needs. Not every patient, not every.
It won't happen.

(43:48):
It won't happen.
Well, we have to end and enjoy... Already? Yes. Already quickly,
right? Yes, already quickly, because it was... First of all, it was fascinating.
It was fascinating. You're talking here about the amount of activity that they really cause.
I've known you for about a year, actually, since I started going around the

(44:12):
Knesset of the Israeli Medical Society and so on.
I remind you that you were at the Oncology Knesset as well, on cooperation between
doctors and decision-making.
There's a situation. And it was 15 years ago. That's it.
Now you've revealed to everyone that you were younger than me. Stop, stop, stop.
But really, thank you very much for your time.

(44:35):
Good luck with everything you do. And of course, patient support,
it seems to me, you've already established it.
Patient support, not patient support. Patient support.
The patient chooses how much to share with the patient.
The patient It's important to be able to listen and to take action.
When I say co-operative treatment, because the right word for it is cooperative

(44:57):
medicine. That means that both sides cooperate and take action.
A joint decision making. They take action and become what he called a treatment team. Yes.
That everyone understands that they are part of one team with a joint goal,
the specific health of each other.
And it's okay, and we said it, and it's important to say that there is something
that will say, what you decided is acceptable to me, and I don't want to be

(45:18):
there. And this too, we need to remember.
We say this a lot, that part of the issue of patient empowerment is his ability
to come and say, don't come alone.
But don't assume he doesn't come alone. Exactly.
But check it out in depth. I think we'll make you a co-host. Really?
Thank you very much. I'm happy to hear that.

(45:41):
Liat, now we'll end with this, if you liked it, tell your friends and your friends.
If you didn't like it, Tzru itanu kesher barashatot hachavoratiot ima telefon.
Dargu utanu bekol aplikatsyot hapodkastim shebaim aten aten vaaten maazinim vemaazinot lanu.
Toda raba ve-bye. Bye, litrot. Litrot.