1-on-1 interview with Prof. Ray Melmed, Administrative Medical Director, iMER

Prof. Ray Raphael MelmedProf. Melmed is our medical director almost from the first iMER days. We met Ray and tried to highlight new angles of one of most interesting iMER team members…

Dear Ray… please give us a view of your biography.

I was born in South Africa, grew up in Zimbabwe, studied medicine at the University of Cape Town graduating in 1961. Then spent a year as a young physician in Bulawayo (then Rhodesia) studying Tropical Medicine, then another year in Gothenburg, Sweden, as a laboratory assistant in a medical research laboratory, University of Gothenburg, then almost 8 years at the Royal Free and Middlesex Hospital Medical Schools, University of London, specializing in General Medicine, Liver disease and Gastroenterology, as well as Biological Research (3 years). Since 1973, a Senior Physician in the Department of Medicine including Head, Department of Medicine A, Hadassah University Hospital, Jerusalem ( a 2 year stint as part of a rotating chairmanship). I was also Head, Unit of Behavioral Medicine in Internal Medicine, as well as Israel Wecksler Professor of Medical Education.

Not all of us fully aware to your unique medical expertise – can you tell us about it?

Early on in my career I became impressed with an area of medical practice between Internal or General Medicine and Psychiatry that was not being addressed effectively by either specialty, but where stress and emotion were substantially contributing to the patients suffering and poor quality of life. These patients were often told by Psychiatrists that there was “no problem requiring psychiatric attention”, but the physicians did not relate effectively to the stress factor other than perhaps prescribe a tranquillizer.

I then took it upon myself to work through the field to formulate a better understanding of the problems, to challenge much of the dogma which, in my opinion tended to hold the subject back, and to integrate the physiology and biology of the field with conventional medical thinking. One of my principal objectives was to break down the enormous barrier between medicine and psychiatry, in order to help make psychiatry more immediately relevant to effective medical practice, which it very much should be. My thinking and analysis were summarized in my book published in 2001 by Oxford University Press, called: “Mind, Body and Medicine; an Integrative Text.”

I personally believe that your specialty is going to be one of the most important specialty in medical care in the next 10-20 years – do you agree with me? Where is medical care going to? What do you think will happen to this profession?

At present and the foreseeable future, technology reigns supreme and we can expect that medicine will first become more technical. Technological medicine is expensive medicine and when practiced to excess, very poor medicine. This tendency finds support in some influential countries because of two principle factors: First, is the proposition that a machine can always do it better than a human (i.e., the doctor), and second, the threat of litigation leading to defensive medical practice where many investigations are needlessly performed – both factors strongly driving the cost of medicine. Every country will also have to legislate to provide better checks and balances to protect doctors from abuse of the legal right to sue doctors. It is a commendable and necessary right that is seriously abused in certain countries, and this tendency is growing. The cost of medical practice is becoming a burden that fewer and fewer countries will be able to afford.

However, history does teach us the cyclical nature of human experience. I do believe that at some critical point the patient will be rediscovered, if only because speaking to and examining the patient is cost effective and much more satisfying to both patient and doctor. A 10 to 20 year timeline may be realistic.

Are you planning another book soon – can you tell us about it?

Ady – this may mobilize others to move ahead on the same or a similar topic. I prefer not to discuss it.

Please give us your iMER D.N.A from your perspective?

Perhaps one of the most positive manifestations of globalism today is the manner in which people may seek medical assistance in other countries. One of the principal reasons that I am enthusiastic about the service that iMER provides is that it is an excellent way for countries that can ill afford to buy and maintain the expensive technology needed, to nevertheless, provide their citizens with top level care at a very much reduced cost. Similarly, it opens up the possibility for many people with serious medical problems to seek medical care of a very high level that may not be available in their home environment. From every perspective this is one of the most positive outcomes of globalization.

Tell us one of your iMER experience that will demonstrate your role.

As “iMER doctors”, we on the medical staff of the organization are committed to winning the trust of those who turn to us for help. As former senior Hadassah doctors this is credo that is engraved in stone, and may be summarized as professional integrity of the highest level. If we see no advantage for the patient in the services we have to offer we say it up front. It is then up to the patient to indicate that, regardless – they want a second opinion, or to look elsewhere. The iMER system works to make sure to the greatest possible extent, that there are no surprises for those who come for medical evaluation or management – that every detail of their visit is presented in advance. This is not always easy with the sometimes minimal information we have to work with, but I am pleased to say that in over 5 years of work in iMER, the number of those who have but disappointed in this regard that I am aware of, can be counted on less than the fingers of one hand.

As a finish to this interview – please reply with the 1st. thing comes to your mind –

  • Your hobbies: reading, writing, art and music, exercise, wine;
  • My philosophy is: keep focusing on the wonder and the beauty of the nature, and the meaningful things in life;
  • I love: loving
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Patients’ Stories

This letter was received from a Turkish family who had a child  stricken with a rare skin problem. Local doctors were unable to make a diagnosis nor recommend appropriate treatment. The parents contacted iMER case manager Michael Von Springer seeking help for their child. An initial assessment of the case was made by the iMER medical director Professor Ray Melmed who referred the patient to the Director of the Hadassah Dermatology department Professor Avraham Zlotogorski. Professor Zlotogorsky examined the child and identified the problem.  Successful
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