Outpatient Clinic

“I think you'd better at least talk to her,” the nurse said as she opened the door to my clinic office.

“Fine,” I replied, “When I finish with the patient I'm seeing now.”

It was Monday afternoon and I was in my weekly outpatient clinic. Every week patients come from around the city to my “cardiology” clinic. The fact that I am not a cardiologist but only a medical resident who sits next door to the cardiologist in clinic and consults with him when necessary does not seem to bother the patients, nor, for that matter, the primary care physicians who refer them to me. What is important to these patients and their doctors is the fact that I sit in a university hospital and as such have access to the top levels of academic medicine—including the cardiologist next door.

On this day, the clinic nurse came into my examining room while I was with a patient and said, “There's an old Russian lady outside who came to see you, but she doesn't have a chart here and didn't even bring a referral letter from her doctor. Even though there's someone with her to translate, I can't understand what she wants. I'm going to tell her to reschedule her appointment and come next time with a referral from her family physician.”

“Fine,” I said.

Since the doors to Jewish emigration from the former Soviet Union opened during the Gorbachev administration, more than 600 000 Jews have arrived in Israel. This emigration has changed the face of Israeli society, with Russian now heard almost everywhere. The health care picture has changed no less dramatically than the rest of society. In addition to an influx of Russian health care providers, …