The Jello-Like Nature of Healthcare Navigation in Israel

The other day I reached the front of the line of my kupah’s pharmacy and met with a huge shock. Apparently, my new, digitally signed, prescriptions had been automatically forwarded to the pharmacy computer and I could pick up the next two months’ worth of my medication, without even bringing in the prescription! (The little things that make us happy.)

The irony of the moment was that I had spent the last 30 minutes waiting in one of those Israeli lines. You know the type? There is a ticket machine, but the paper is out (as it has been for the last 6 weeks) so your number pops up on the screen and you have to remember it. However, the video system in the pharmacy isn’t working so you are doomed to repeat that ever popular phrase of the Israeli language, “Who’s the last in line?” You nod to your new partner in crime and say, “Okay, I’m after you.”

Then you have the choice. Do you go and do other errands and risk the worry that you may arrive as your partner is already at the counter, and then have to state to the room, and the cranky woman standing right behind your partner in crime, “I was after him.” To which the cranky lady makes a face as if to say, ‘Liar!’ and the rest of the room looks on with blank boredom and slight hostility. After all, why aren’t you waiting in morbid silence like the rest of them?

It is this crazy contradiction, enormous efficiency on one hand, and the inability to create a sensible line wait on the other, that is this country.

This inconsistency reminded me of something that I had heard not long ago in a focus group I was conducting with physician residents. (In addition to healthcare advocacy, I also coordinate community-based research for academic institutions). The topic was how to help specific medical professions in Israel experiencing severe shortages: namely, emergency medicine, geriatrics, anesthesiology, and family medicine in the periphery. I brought several examples of other countries and how they have addressed these shortages and asked the group whether they felt these programs would work in Israel.

One resident summed up everyone’s feeling quite clearly. “This is not Scandinavia. That would not work in Israel. I don’t trust the government to keep any incentive program going long enough for me to believe it would be there when I finished my residency.”

‘Wow’, I thought to myself. ‘That’s harsh’. But that, I realized, is what makes it so difficult to affect systemic change in this country.

Simply put, many Israelis don’t have belief in the system, so why should they change their behavior if the external environment is just going to change around them again? Soon.

For those of us who came from Westernized countries with tickets and straight lines, we are a bit bamboozled by the inconsistency. How do we navigate effectively, when the rules and the infrastructure feel like Jello?

Obviously, you will not change the culture, or even the pharmacy, but there are things you can do to help yourself in the situation.

Here are some DO’s and DON’T’s to help you keep your cool, and get some stuff done directly.

DO take notes, and always get the worker’s name and direct number if possible.
DO keep asking your question if you feel that you have not received an adequate answer.
DO NOT yell, curse, stomp, or throw something.
DO rephrase your question, ask to speak to a manager or see the issue in writing.
DO speak in English if you feel yourself at a loss for words.
DO NOT give up if the issue is very crucial to you.
DO choose your battles; is this issue important to you financially? Physically? Or is it just the principle of the matter.