Dr Michaela Bercovitch, EAPC board member, Chair of Israel Palliative Medical Society, Head of Palliative Care Department, Sheba Medical Center, and a lecturer at the Sackler Faculty of Medicine, Tel Aviv University, Israel. Continuing our series about the Budapest Commitments, we look at how Israel is doing.
As others have described in previous posts, we also used the Budapest Commitments as a framework to develop palliative care in Israel. We chose two goals: the creation of a palliative medicine specialty and to increase efforts for teaching the goals of palliative care. This post traces what we did to achieve these goals but you will see that our story goes back a long way.
It took 29 years of solid work and persistence but finally in May 2012 palliative medicine became a subspecialty in Israel. Our story began in 1983 when the first hospice department opened at the Sheba Medical Center, Tel Hashomer. Since then we have cared for more than 50,000 patients and taught the secrets of palliative medicine to physicians and nurses across the country. Similar departments have opened, including home care hospice services.
First steps to gaining recognition
We created the Israel Palliative Medicine Society (IPMS), held meetings, wrote a journal, published papers and taught, but our work was not recognised as a scientific part of medicine. In 2003, I was elected Chair of the IPMS and promised to begin the process of attaining recognition of our work as an important part of modern medicine. Many teaching courses have been offered over the past ten years, including a postgraduate diploma course in palliative medicine at Tel Aviv University, and in 2008 palliative education was introduced for fourth-year medical students.
In 2005, supported by Stephen Connor (former Vice-President of NHPCO (National Hospice and Palliative Care Organization in the USA) we submitted a proposal to the Scientific Committee of the Israel Medical Association (IMA) for recognition of palliative medicine as a medical subspecialty. With the approval of other medical specialties, we prepared a syllabus for academic palliative education and a list of potential mentors from among senior palliative care practitioners. In 2009, the Physicians’ Scientific Committee (PSC) opposed our proposal, one argument being that the new specialty would discourage other physicians from general treatment of the terminally ill. Instead, they suggested we accept a fellowship formula. But after consulting with IPMS members we refused this alternative and submitted a revised proposal. We were asked to name two specialists who worked in palliative care departments before they would be prepared to reconsider our proposal.
During the summer of 2011 the board of the IPMS, together with Professor Pesach Schwartzman, Chair of the Ministry of Health Commission for the Organisation of National Palliative Care Services, submitted a new proposal to the committee. In February 2012, at the first meeting for the approval of medical specialties I presented the current situation of palliative care in Israel and its importance as a specialty. At the end of the meeting there were 100% votes in favour of creating the new specialty. Further successful meetings followed and on 21 May 2012 we received the final answer: palliative medicine was a recognised specialty in medicine in Israel.
The process of recognition continues at Ministry of Health level; we still need their input concerning dedicated positions and recognition of leading centres for teaching, and the contribution made by the pioneers of palliative care in Israel. But though difficult, this is only logistical and technical work. The most important thing is that palliative medicine has been entered as a new chapter in the ‘great book of Israel medicine’.
Find out more…
Click here to read how other national organisations have used the framework of the Budapest Commitments to develop palliative care. All published material also appears in Dr David Oliver’s guest editorial in the May/June 2013 issue of the European Journal of Palliative Care and will be presented at the 13th World Congress of the European Association for Palliative Care in Prague 2013.