2023-06-02 10:31:36
Studies show that there are patients who refuse to receive treatment from a medical staff member of another nationality or demand that the treatment be given by a professional who belongs to a certain ethnic group. A new study shows that even in the health system in Israel, the encounter between a patient and a nurse is influenced by the prejudices that Jews and Arabs hold towards each other.
The researchers wanted to check, for the first time in Israel, whether Israeli patients have preferences regarding the nationality of the nurse who treats them and whether there is a difference in the level of trust they feel towards brothers and sisters of different origin than their own.
According to the findings, most of the patients in the health care system in Israel, both Jews and Arabs, prefer that the care they receive be from a brother or sister of their nationality. Likewise, the level of trust in the therapist of the same nationality was rated according to the therapist’s preference.
It was also found that even when it came to patients living in mixed cities, the preference for a therapist of the same nationality did not differ from that in homogeneous cities as well as the level of religiosity (secular, religious and orthodox).
1,012 Israeli patients were included in the study, of which 534 (52.8%) were Jews and 478 (47.2%) were Arabs. The data was collected with the help of questionnaires distributed on social networks. The study included a similar number of women and men aged 18 to 78 (average age 47), education level – average 15 years of schooling. Among Arabs, 43% were secular, 28% traditional and 29% defined themselves as religious. Among the Jews, 33% defined themselves as secular, less than 1% defined themselves as traditional, 46% defined themselves as religious and 21% ultra-Orthodox.
Dr. Fazit Azuri, head of the digital medicine track at the Faculty of Business Administration in the College of Administration, who is also a registered nurse, led the research, alongside Dr. Ricky Leshem-Halamish and Dr. Yaarit Bokek-Cohen from the Israel Academic College in Ramat Gan, and Dr. Mehdi Tarabia from Tel Aviv-Yafo Academic College. Its results were presented yesterday (Wednesday) at the annual conference of the National Institute for Health Policy Research.
Dr. Fazit Azuri, head of the digital medicine track at the Faculty of Business Administration at the College of Administration
The research participants were asked to answer questions regarding basic operations such as giving an infusion, dressing or taking vital signs such as blood pressure and pulse, “this is to ‘clean’ all kinds of other considerations that might affect the results,” explains Dr. Azuri. According to her, this is also The reason they gave was that they focused the research on nurses and not doctors.
The answers were on a scale of 1-6, with 1 indicating “do not agree at all” and 6 indicating “strongly agree”. The analysis of the answers showed that Arab patients preferred an Arab nurse (average score of 5.13 for the Arab nurse, compared to 3.4 for the Jewish nurse). The level of trust of Arab patients in an Arab nurse stood at a score of 5.5 compared to 4.07 for a Jewish nurse. Similar results emerged from the answers of Jewish patients who preferred a Jewish nurse (4.96 compared to 2.16 for an Arab nurse) and their level of trust in a Jewish nurse was 5.61 compared to 2.54 for an Arab nurse.
The level of religiosity and traditionalism had an effect on the attitudes. A clear preference was found among religious Jews for care from a Jewish nurse. In the case of the Arab patients, the more traditional the patients were, the greater their preference for an Arab therapist
Even in the mixed cities, Jews preferred to receive treatment from Western Jews and Arabs. Illustration photography
The bias of the Jewish patients regarding the level of trust in nurses of Arab origin, compared to that of the Arab patients (2.54 compared to 4.07) is explained by the fact that Arabs know more Jews, while Jews living in a homogeneous environment know fewer Arabs and therefore the score regarding the level of trust is lower.
The level of religiosity and traditionalism had an effect on the attitudes. A clear preference was found among religious Jews for care from a Jewish nurse (5.9). For the Arab patients, the more traditional the patients were, the greater their preference for an Arab therapist – 5.4 compared to 4 for non-traditional Arab patients. Among the Jews, there was no gap between preference for a Jewish therapist among traditionalists (3.9 vs. 3.2).
Dr. Azouri states that she was surprised by the results of the study: “I thought that in the health system there is no place for consideration of nationality in treatment, but for consideration of professionalism and trust in treatment according to the ethical code, regardless of religion, race and gender.”
The researchers conclude that trust is the most important factor influencing patients’ preferences regarding the nationality of the nurse treating them.
There is no place for patient education
“One should not be angry with patients who prefer to receive treatment from a mitzvah of the same nationality, one should accept their preference with understanding, of course one should not pressure or preach morals,” says Prof. Bashara Basharat, chairman of the Society for the Promotion of the Health of the Arab Population in the Medical Association, an expert in medicine, referring to the results of the study Family and lecturer for cultural adjustment in the health system at Safed College. “I believe”, he says, “in showing compassion and tolerance towards the patients”.
Prof. Basharat: “News for Jewish and Arab mornings in this country are constantly flooded with information about conflict, terror attacks, and attacks on Palestinians. It is not easy for patients to suddenly change phase and see a redeeming angel in a medical staff member of another nationality, whether a doctor or a brother.”
Prof. Bashara Basharat, Chairman of the Society for the Promotion of Health in Arab Society”
The results of the study do not surprise Prof. Basharat at all. As someone who is in the health system and has worked in hospitals since the 1980s, he knows the phenomenon and understands its roots. “Despite the excellent atmosphere between Jewish and Arab teams in the health system, which constitute the sane anchor of the country, I am not surprised. The news for Jewish and Arab mornings in this country is constantly flooded with information about conflict, terrorist attacks and attacks on Palestinians. It is not easy for patients to immediately change their phase and see a savior In a medical staff member of another nationality, whether a doctor or a nurse.”
As an example, he tells of a case of an attack in Jerusalem, where one of the victims of the attack refused to be treated by an Arab doctor. “All the doctors were busy, there was a difficult situation in the emergency room, but there was no choice – we had to respect her request, and that’s leadership.”
Understanding cultural diversity
It is customary to look at the health system as an island of coexistence and indeed, today there are more Arab personnel – nursing and medical – in the health system. The CBS data shows that today 68% of Arab employees in the civil service belong to the health system, and in many medical professions their representation is higher than their share in the population. 25% of all doctors, 30% of public health nurses, 27% of X-ray technicians and about 30% of pharmacists are Arabs.
“This is the only profession where there is almost no glass ceiling like there is in high-tech, in government mechanisms and in the education system,” notes Prof. Basharat.
When asked how the entry of Arab staff members into the health system affects the patients, he explains that traditionally, the Arab population is used to receiving treatment from Jews – doctors, brothers and sisters. But, with the entry in recent years of more Arabs into the health system, the numbers balance out.
“In the 1980s, when I was a doctor in a hospital, there were less than 10% Arab doctors in the hospital. In my experience, Arab patients who encountered a doctor or medical staff member who spoke Arabic, were happy and preferred to consult him, without looking at the level of the doctor, without examining If he is an expert, senior or junior, to me, it makes sense that they would feel more comfortable with someone who knows the culture and can speak the language, especially with adults, some of whom did not know the Hebrew language and therefore were comfortable with an Arab therapist taking care of them.
Prof. Basharat: “It’s not just about receiving treatment – sometimes a Jewish family comes and doesn’t want to enter the room in the ward where an Arab patient is hospitalized, and this is also an issue that is not dealt with in medical schools and needs to be given space for that.”
“Not only that,” says Prof. Basharat, “but there is also a need to understand the cultural differences, the cultural rules of the patients. For example, a religious girl should not be asked by her parents if she is taking contraceptives,” he explains.
The responsibility of system administrators
Prof. Basharat is not surprised, as mentioned, by the research findings, but he has some ideas on how to improve the situation. “This is a big challenge for the health system and the teams,” he says. “Our goal is the benefit of the patient, for him to feel comfortable and have confidence in the system and a feeling that the team only wants his best interest. In the time we are in, when there is still no peace and the Jewish-Arab conflict has not been resolved, in my opinion the more cohesive the teams are and continue to be a strong sane anchor, they can To influence the patients. In most cases, it is a matter of teamwork – the patients see more than one person. The more patients see the teams together, the greater their trust, and even when it comes to a department where religious patients are hospitalized, they have less trust.”
The research data, in Prof. Basharat’s opinion, should be disclosed to hospital employees. “If I were a hospital manager, I would have a conversation with my staff about these data and hear their opinion on how to increase trust.”
What practical ways do you recommend?
“It is possible, among other things, when doctors visit the ward, to tell the patient on the first day of hospitalization that there is a Jewish and Arab staff, we all took the doctor’s oath and the treatment in the ward is equal. If there is a patient with preferences, they must be taken into account if possible.”
Prof. Basharat cites as an example the Shmuel Harofeh hospital, where the doctor’s oath hangs in the doctors’ rooms in Hebrew and Arabic: “And help the sick person regardless of whether he is sick, if he lives, if he is a stranger, if he is a citizen, if he is injured and if he is honored.” We, the doctors, will never break this oath and I think I say this on behalf of everyone.”
However, he emphasizes: “The question of whether resilience is ever relevant, and in my opinion the answer is that it depends on us, on the leadership of the Israeli health system. In order to preserve this sane anchor, we need to invest in workshops and discussions for teams so that there is no case of a young doctor who just entered the system and feels insulted because He was refused treatment and he has no one to talk to about it. We need dialogue and for our leadership to take care of us, so that it doesn’t affect us. Hospital administrators need to know how to deal with a staff member who feels bad after being rejected by a patient.
“It’s not just about receiving treatment – sometimes a Jewish family comes and doesn’t want to enter the room in the ward where an Arab patient is hospitalized, and this is also an issue that is not dealt with in medical schools and needs to be given space.”
Prof. Basharat says that two years ago, after the flare-up of events in the cities involved, he was a participant in a study day on the subject held at the Furia Hospital. “I also presented the issues to the director general of the Ministry of Health at the time, and there is a desire and willingness on the part of the ministry’s management that the issue be handled professionally in order to preserve the sane anchor. The current study reinforces the need for the conservation plan.”
Finally, what would you say to a staff member that the patient does not want to receive treatment from?
“A staff member should understand that this can also happen to a colleague of another nationality. As an Arab, I can understand that this can also happen to my Jewish colleagues.”
“I developed elephant skin”
Dr. Mehdi Trebia, a lecturer at the School of Nursing Sciences at the Tel Aviv-Jaffa Academic College, who was a member of the team of researchers, explains that the decision to examine the issue with brothers and sisters and not doctors is because they come into much more direct and intense contact with the patients.
Dr. Mehdi Tarabia: “When people treat me with racism, I ignore it, pretend not to hear and continue to behave professionally. I try to be as professional as possible”
Treatment of hospitalized patients. Illustration
“I have worked in many hospitals in Israel,” he says, “and I have come across quite a few cases where patients preferred their ‘own’ therapist, or in the room where they are hospitalized there will be patients of the same nationality. A Jewish patient who prefers a Jewish doctor or brother, this is not a rare event, but all cases There were patients towards the team. Within the teams I never encountered this and on the contrary, there was always support and protection for each other.”
Is there a case that you particularly remember?
“Yes, many years ago an ultra-Orthodox family from Jerusalem came to the hospital where I worked. They were sent to me by a rabbi and did not know that I was Arab. When they arrived, they announced that they preferred to receive treatment from Jewish nurses. The director of the department explained that I was the only one providing the treatment and that they could to go to another hospital. Since it was Friday before Shabbat, they stayed and received the treatment from me.”
How do situations like this affect you?
“When people treat me with racism, I ignore it, pretend not to hear and continue to act professionally. I try to be as professional as possible. I have developed an elephant’s skin.”
Dr. Tarbia says that during his career he worked in hospitals in Belgium, Denmark and the USA and there he did not encounter patients who refused to receive treatment because of origin, religion or nationality. However, he was not surprised by the results of the study either.
“I was not surprised that more religious people, both Jews and Arabs, were more strict about choosing therapists. What did surprise me was that in the mixed cities, such as Lod, Ramla, Jerusalem, etc., the data were not different – even there Jews preferred to receive treatment from Jews and Arabs from the West . I thought that the places involved had more familiarity and the level of trust would be greater. Perhaps this reflects the fact that the questionnaires were sent around the time of the outbreak of violence in Israel, but I am not sure that this is the explanation. Unfortunately, politics in Israel also invades the health system.”
In conclusion, he says: “In order to make a change, we need to start with education. If we teach our children, at home and in schools, this phenomenon may decrease.
(The full study is under peer review and will be published in the scientific journal Journal of Religion and Health)
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