1/11/96

The ‘Kacha Zeh’ Syndrome

By: SAM ORBAUM

IT was one of the most satisfying moments in my life. I was in Hadassah-University Hospital Ein Karem to register for a medical procedure. When the interminable process was finally finished, I happened by Prof. Shmuel Penchas, lord of this vast institution. He had also happened to see me when I first arrived.
    "Why are you still here?" he asked. I explained my business. "Yes, I know, but what took so long?"
    I rattled off the list of steps I had had go through, the back-and-forth, the running around, the long queues nothing any visitor to Hadassah isn't resigned to.
    Penchas exploded. He rounded up his most senior staff and practically blew his lungs out at them: "This man has been here for two-and-a-half hours for nothing!" He upped his rage even further: "I want to know what's going on around here!!" He then ordered his head nurse to make a report of every step I'd taken.
    I found out later that, sure enough, the process had been significantly streamlined.
    As a speck in the vortex of a colossal bureaucracy, I had been chosen by fate that day to Do Something About It. Unfortunately, it seems Prof. Penchas stopped there.
    I don't know if the bureaucratic monster is any worse at Hadassah than at other Israeli hospitals because when I need such services I always seem to end up under Penchas's roof. For all I know, maybe all hospitals in the world are like this.
    I don't care; it's wrong.
    More recently I was back at Hadassah for a different procedure. I was told to come in at 9 a.m. Apparently, all patients scheduled for that treatment that day were told to come at 9 a.m.
    After waiting an hour I politely asked how much longer I should expect to wait: five minutes? Two hours? The nurse in charge snarled at me that she couldn't say and that I shouldn't bother her any more.
    I ended up waiting five hours -- on a total fast that had begun 15 hours earlier. I was unable to eat or drink or move off my plastic chair in the waiting room in case I should miss the call; unable to get some idea of how long I still had to wait. I was gnawed by anxiety and fear of what I knew to be a nasty procedure and further upset by the obnoxious attitude of people who were supposedly familiar with the Hippocratic Oath.
    And when they finally fetched me the nurse chafed me further, pushing me up to boiling point.
    A hospital should be especially sensitive because its public is by nature nervous, worried, emotionally vulnerable; but such low expectation prevails that we meekly accept this arrogant indifference, this salt on our wounds, as normal.
    The nurse as much as admitted it. "I'm not saying it's right," she shrugged, "but kacha zeh -- that's the way it is."
    Maybe -- but that's not the way it has to be.
    With a few heartwarming exceptions I have found cynical disregard to be pandemic in Hadassah-Ein Karem.
    One conscientious doctor, relatively new to Hadassah, told me he "knew something was very wrong" when patient after patient began thanking him emotionally for his sympathetic manner.
    And it isn't just the surliness or the unnecessarily bloated bureaucratic process. The array of wrongs I have come across at Hadassah in the last few years is staggering:
* Hospitals use a ploy to cheat the health funds by checking a patient in on a Thursday for an operation the following Sunday, then immediately discharging him for the weekend, thereby claiming two or three extra days of phantom hospitalization (and, of course, needlessly inconveniencing the patient);
* After waiting in interminable queues exasperated patients then have to wait yet again -- in my personal experience for as much as two hours -- for a medical file to be delivered from the archive;
* "Appointments" are bunched together so that hordes of people arrive at the same time. Sometimes (like with me) the final patient of a day can be told to arrive at the same time as the first patient;
* I once nearly lost a loved one on the operating table when a surgeon accidentally sliced her aorta. The hospital steadfastly refused to provide an official report of the operation, a patient's basic right. (We only found out from a nurse, who was witness to the accident.)
* A doctor wanting to see a test result told me he couldn't arrange for it to be brought to his office in the same building. I was expected to take time off work, drive to the hospital, pay for parking and walk hither and yon to pick it up off one desk and put it down on another;
* I saw a patient in agony curtly turned away by the Emergency Room admittance clerk because he didn't have his ID card on him;
* I was strapped down in a CT scanner, then abandoned for 45 minutes; my condition was such that, trapped in that position, I could easily have choked to death. Yet no one checked on me in all that time.
    In every single instance, when I objected to the injustice I came up against the kacha zeh syndrome.

TRUCULENCE on the job can be cured: Yitzhak Kaul, the country's wizard administrator, transformed attitudes first in the Postal Authority and then -- who would have thought it possible? -- at Bezeq.
    Workers at both institutions have been affected by Kaul's enlightened user-friendly, anti-bureaucracy concepts. Kaul's employees have high morale, which rubs off on the public: Kaul has succeeded in breaking the vicious cycle of uncivil civil servants serving an antagonistic public.
    At Hadassah, and anywhere else the kacha zeh syndrome pervades, employees at all levels should be motivated to snap out of it, and think.
    At least as much intellectual industry should be spent on building a better hospital environment as building the proverbial better mousetrap.
    Sure, it's easy to complain, but what to do about it?
    Well, Penchas could yank away a handful of staffers from their miserable jobs rubber-stamping forms and put them in an aggressive, high-profile new department to achieve the following: slash bureaucratic processes; arrange a program to encourage compassion; provide on-the-spot response to public complaints; transform the staff's morale and remind them exactly what kind of work they're involved in.
    Yes, I know, it ain't done -- but who's to say it can't be? Heck, if Hadassah can afford the resources for its own Tourism Center, it can invest a little kindness in its heavily-taxed clientele.
    Certainly Hadassah and Penchas have marvelous achievements to their credit. Israelis are fortunate to have access to such a scientifically advanced facility. It engenders a sense of assurance in a chronically health-conscious nation. Its brand-new Mother & Child Center, which I toured recently, is a gem.
    How sad, then, that such a wondrous place is infected with such woeful attitudes.
A hospital that shows little concern for human dignity and emotional needs, that behaves as if it resents sick people interfering with its work should perhaps be limited to treating prisoners of war.

NOTE: Response to this op-ed was enormous – one result was the launching of the “Not Page One” column. It should be noted that – whatever influence there was from this op-ed and the response to it – attitudes at the hospital did improve, greatly.