What the Talmud Says About Doctors
Sep 14th, 2010 | By admin | Category: 2006-7, Archivesby Rabbi Yisrael Rutman
It’s not nice what the Talmud says about doctors: “The best of the doctors—to Gehinnom!” Gehinnom, for those who may not know, is not the place where they hand out the Nobel Prize for Medicine. That’s in Stockholm. In Gehinnom they don’t hand out prizes for anything, because in Jewish tradition it’s the place you go when you leave this world, if you don’t merit to go straight to the eternal rewards of Gan Eden.
The question you may ask is: “I can understand that the worst of doctors should go there. But why the best?” It’s a good question, but don’t think you are the first to ask, far from it. The question has been around probably at least as long as the Talmud itself.
We find that Rashi, commenting on the relevant Talmudic passage (Kiddushin 82a) back in the 11th century, addressed the question. He offered three explanations: (1) they are unafraid of illness and unsubservient to the Omnipresent; (2) they kill people; and (3) they are able to heal the poor, but fail to do so. The Ramban, himself a doctor, qualified the criticism, pointing out that the condemnation applies only to those who are negligent. But medicine is assuredly a source of merit for the diligent practitioner.
The Maharsha took the Talmud to mean that one who considers himself “the best,” and therefore shrinks from consulting others or taking precautions, such as additional tests, just in case he might have erred. Such arrogance is a ticket to Gehinnom.
The Kana Avraham explains it in terms of a doctor whose goodness is misplaced. His kindly nature leads him to spare the patient painful but necessary treatment. He never learned the Shakespearean injunction to be cruel only to be kind.
Contemporary experience confirms the Talmud and its commentators. “Doctors kill” may sound like an extreme statement; but in 1999, the National Institutes for Health in the United States revealed that as many as 98,000 patients die each year from medical error. An estimated 7,000 of those fatalities are attributed to sloppily written prescriptions that lead to the wrong dosage or wrong medicine being given. Over a million more are sickened, though not unto death.
As for social inequity in health care, the Washington Post reported: “A National Health Survey conducted by the U.S. Centers for Disease Control and Prevention found more than 40 million people of all ages went without insurance at some point in 2005. More than half remained uninsured specifically because they simply couldn’t afford it, the CDC said. Research consistently highlights the negative link between reduced income and worsening health — as salaries drop, individuals tend to be more stressed, and generally lead less-healthy lifestyles.”
And as Discover (May 18, 2007) put it: “To suggest that doctors prefer chasing dollars over treating real disease might seem unfair, but the facts speak for themselves: In 2005, doctors performed over $12 billion worth of cosmetic surgery while, according to some experts, up to a third of our diabetics and hypertensives received inadequate care. Meanwhile, the proportion of U.S. internal medicine residents planning to enter primary care continued its slide from one-half (in 1998) to one-fifth. Why? Money rules. The average American medical school graduate takes on $130,000 in debt (European grads face much less). If some idealistic premed didn’t care about money when he started, he sure will when he graduates—as a radiologist or a dermatologist. At some point this siphoning of talent away from primary care has to undermine that field’s research and clinical skills.”
Surely, we would prefer a warm, caring doctor to a cold, impersonal type. Yet, Harvard Medical School’s (and The New Yorker’s) Dr. Jerome Groopman recounts the case of a physician who refrained from turning a patient over on his stomach, so as to spare him any unnecessary discomfort in his frail condition. As it turned out, the emergency that ensued not long after might well have been prevented had he examined the patient from the back, where he could have seen the tell-tale symptom of the infection that nearly killed him.
Decades of holding doctors in awe for their oracular medical knowledge have given way to a new attitude. Today, the patient’s right to a second opinion is universally acknowledged and even enshrined in the clauses of health insurance policies. One is no longer captive to the doctor who considers himself “the best” and will brook no questions. Rabbi Shimon Rogoway, director of medical referrals at Ezer MiTsion, the Israeli medical assistance organization, declares his rule of thumb: “I have learned from experience that doctors who…are not arrogant make fewer mistakes…If I am faced with two equally qualified doctors, but one is more modest, I will recommend him, because he actually will err less” (Mishpacha).
How did the Sages of the Talmud foresee the present situation? They came centuries after the period of the prophets, and did not foretell the future. But the answer is simple. Though medical technology has changed immensely since Talmudic times, human nature has not. Therefore, it was to be expected that the human shortcomings of doctors would be reflected in modern practice, as well.
To be fair, I should say that I have not included all the interpretations of the Talmud Kiddushin. Not long ago, I heard a very different one. That the best of doctors are consigned to Gehinnom because those who are most dedicated to the welfare of their patients, experience a kind of Gehinnom here on earth, as they suffer along with them and share in their personal tragedies. We have probably all been fortunate to know and be treated by such people. They are not so few or far between, and theirs will be a ticket to Gan Eden, non-stop.
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