I organised a three week placement in Dermatology at Hadassah Ein Kerem in Jerusalem, Israel. I chose it on the basis of furthering my clinical exposure to as yet unseen conditions as I did not have any prior experience in dermatology. I was very grateful for the educational opportunities at Hadassah.
I attended a number of dermatology clinics whilst I was there, including the atopy, alopecia, general dermatology, skin cancer clinics as well as a paediatric general clinic. I saw a variety of conditions, both rare and common, and had the opportunity to become more comfortable with using a dermatoscope. It was useful to see how a systematic approach is needed for skin examination - some doctors would do a top to toe scan and examine suspicious lesions as they came to them; others would examine the lesions the patient had concerns about first before doing the general examination. It was also interesting to see how the (mostly) Hebrew-speaking doctors treated the Arabic-speaking patients. Despite all the conflict that has been so comprehensively covered in the news, it was heartening to see that these doctors put aside any possible prejudices and focussed on treating that patient as a human being. They gave them the same care and attention as Hebrew-speaking patients. Their professionalism was to be commended.
The patient population had a mixed ability with respect to speaking English. Some were totally fluent and happy to speak in English during consultations whilst others only spoke Hebrew/Arabic, with the doctor translating for me. Although the translation was vital in understanding the details of the presenting complaint, it really highlighted the importance of body language and gestures in communication, as I was able to still glean a great deal of information while the patient spoke to the doctor. Ultimately, this elective period has improved my ability to use these often-neglected facets of communication, and I am sure I will carry this into my clinical practice going forward. Thus the placements have not only furthered my clinical knowledge but also extended my communication and examination skills.
In terms of furthering my more formal education, I atended journal club and case-based teaching. The later was particularly useful as the patient pathway could be followed from beginning to present/ end. My elective was also a good opportunity to see how the Israeli system worked relative to the NHS. In Israel, you are taxed by the government and then apply to one of four non-profit insurance providers (called Kupat Cholim). These providers have a list of basic services and medication they provide, and you can purchase more extensive coverage either from them or from a commercial provider. Overall, the standard of management seemed excellent, with patients appearing satisfied with the care that they received.
Ultimately, I had a fantastic time on elective. I wanted to explore dermatology more and I was successful in achieving this aim. I managed to see many new conditions and how they are managed. I also really enjoyed exploring Israel. Notable memories include a strenuous dawn hike to Masada, enjoying the beach in Tel Aviv and spending Shabbat with a local museum guide and his family.
I would like to extend my thanks to the Jewish Medical Association UK for their support in making this opportunity possible for me.
Irene Jessel (Cambridge)
