Wednesday, December 26, 2007

Medical Ethics: How To Be an Orthodox Jewish Physician in a Secular World

Disclaimer: These notes are unofficial and unedited. Any and all mistakes or misquotations are mine.

To the best of my knowledge, this event was not sponsored by the YU Medical Ethics Society, but rather by SOY, TAC, YSU and YC.

Thank you all for coming- privileged to host Dr. Abraham S. Abraham- author of Nishmat Avraham- he translated it himself into English- one of the authoritative books that we have on Medicine & Halakha- he won’t admit it but most people acknowledge him as one of the experts in the field of Medical Halakha- zechus to hear from him today on what it means to be a frum person engaging in the world of medicine, in our world.

Rabbi Abraham:

Thank you first of all for having me here to speak to you- can you all hear me now? Does this work? (No- so they adjust it) Is that better?

I was asked to speak about the Jewish physician- and the question really is what is the difference or what should be the difference between the Jewish physician and the non-Jewish physician. I am going to assume that people who go into medicine go into it for altruistic reasons- not interested in the kavod or the money- they want to help people. Certain doctors who are at the top of their field earn very good wages- all of you should have your heads examined if that’s the reason you want to become doctors- you can go into computing and make big money. I assume therefore that most people, including non-Jews who go into medicine do this because they want to help people.

So if everyone wants to help people and be good doctors-what should be the difference between you and the non-Jew, you and even the non-religious Jews? You’ll learn the same treatment, learn the same medicine- why should you be different- just because you wear a kippah on your head and your tzitzis sticking out-is that the difference between a Jewish frum physician and the rest of the world?

First of all, is there a mitzvah to be a doctor? Or does your mitzvah start after you have your MD and you have hands-on responsibility for your patients? Most poskim pasken that there is no mitzvah to be a doctor. R’ Moshe Feinstein in one of his teshuvos talks about a kohen who wants to become a doctor- and the Rav of that kohen says this kohen wants to become a doctor even though in the process he’s going to be m’tamei l’meitim. He’s going to come in contact with corpses and anatomy later on- but he wants to become a doctor- after all he’ll be doing tremendous mitzvoth saving lives- mitzvah haba b’aveirah but- R’ Moshe Feinstein writes that if there was no other doctor in that city or in the world, been a long time since he’s looked at this teshuva but still, at this moment in time when he becomes a doctor and saves Jewish lives- if he wasn’t to become a doctor and due to that other Jewish patients would die- it is still assur for him to become a doctor.

In other words, today when you are a medical student you are not doing a mitzvah.

Remember when in the States this young person comes over to me and said he had the zechut to meet R’ Sheinberg from Eretz Yisrael who was here and he [the student] went up to him and asked this question and said- is there a mitzvah to become a doctor? R’ Sheinberg took my hand and said “I don’t know if there is a mitzvah to become a doctor- I do know that there is a mitzvah to learn Torah.”

The girls, I don’t know- the girls don’t have a mitzvah to learn Torah, so maybe they have a mitzvah to be a doctor- but they do have a mitzvah to be a housewife and not have some goyish woman raise the children- but whether you are a boy or a girl it’s a problem.

However, I heard from R’ Auerbach z"tl that even though THE mitzvah with a capital T for a boy is to learn Torah and only Torah- he recognizes the fact that not everyone can do this. Either because your brain is so built that sitting for 16 hours a day or so- you can’t do this- go to a daf yomi shiur and be a nice baal habayit- already married or perhaps financial reasons- good reason why you cannot sit and learn all day- then if you are going to go out into the business world then there is a mitzvah of all the things you could do, there is a mitzvah to become a doctor or some kind of medical profession- doesn’t matter if you have an MD behind your name or are a radiographer, not just a radiologist- help people who need your help- to hand money as a blank clerk over the counter- not really helping him, because it’s his money anyway- so if you are going to do something anyway, then there is a mitzvah to be a doctor.

This is the pesak of most of the poskim who I have asked in the past- going along with that, if you are going to be a doctor, you are learning, you’re a medical student already- assuming you have a mitzvah because you cannot learn for some reason- then you have a mitzvah, therefore if if is a mitzvah, are you allowed to do that mitzvah on Shabbos? So I’ll learn- I’ll learn medicine- going to learn on Shabbos- is this true or not true, right or not right?

R’ Auerbach ztl differentiated between before MD and after MD. When you already have your MD it is a mitzvah to learn medicine on Shabbos- whether reading a textbook, going over notes from lectures- it’s a mitzvah to learn on Shabbos. Before MD, since there is no mitzvah to become a doctor in the first place, even though you have a “heter” to become a doctor because you cannot learn- you cannot learn it- no difference between you and bank clerk who cannot learn clerking on Shabbat- so I asked him what’s the difference? Today you are one day short of your MD and next day you will have your MD, and difference is Shabbat. And he answered very nicely- said that when you are a doctor, you are learning to save lives- even though that patient you are learning about in Harrison or whatever textbook is not under your care- but tomorrow that patient may arrive- and when he arrives and he happens to be an acute emergency, you can treat him immediately- you can’t go to the library and start looking up things- but a medical student is learning to pass exams; he’s not learning it to save lives. Maybe in four years time, three years, one year you are learning to save lives- but for now you are learning ot pass exams, and that is not a heter for learning anything but Torah on Shabbos.

One of the main, in my opinion, points that differentiates a frum student or frum doctor from a non-frum doctor or a non-Jewish doctor is halakha. The halakha which all of us are mechuyav to keep whether you are a doctor or not a doctor. But when you as a doctor, walking the floors of a hospital, Jewish or non-Jewish and you stand out as being different from the Jew who unfortunately is mechalel Shabbos- or the goy who is your partner. And when you stand out, not because of your dress- that’s taken for granted- but in your behavior- which is different from the accepted norm of behavior of the other two people that I’ve mentioned- you stand out- you’re doing another mitzvah. The mitzvah of Kiddush Hashem. And when you don’t, you are doing the aveirah of Kiddush Hashem- and why? Because you have a cap on your head- as opposed to Jewish doctor who does not have a cap on his head- the goy looks upon him as a Jew who is not really religious- but you walk around with that and do something which even if it may be correct, but in the goy’s eyes or your non-frum friend’s eyes, it’s something that should not be done- then you are guilty of Chilul Hashem. And when you do the opposite, there is no greater opportunity for doing Kiddush Hashem than in the medical field- you’re a doctor, you stand out. And whether you like it or not, whether you’re a person who is full of anava- you stand out- you’re a doctor- now you wear a stethoscope around your neck- in my time no one wore a stethoscope around their neck; putting it in your pocket is not good enough.

Yesterday in the meeting they had this thing about China- R’ Elyashiv paskening about people going to get organs from Chinese criminals executed by the government and whose organs were sold to those with the highest things- you may not recognize that I’m a doctor, and therefore putting a stethoscope around my neck-

But it’s what you do with your tzitziyot, it’s what you do with your stethoscope that counts-

Every single day you can do a Kiddush Hashem that you can’t do in every other profession- when you sit in Kollel and learn, nobody sees you- you’re not open to the world. When you walk the corridors of the hospital, you’re open to the whole world- and this is way and above the lives that you save- that’s also Kiddush Hashem, of course it is- but that’s to me the difference between- and it’s nothing to do with beards or the color of your kappel. It’s how you behave.

Number 1- I think these points are sometimes forgotten- most people, and I don’t want to say everyone, minority or majority, but it’s well known that doctors all over the world are on a higher level or behave as if they are higher human beings than the nursing staff on the world. First of all, I have much more knowledge- what does she know? But she know things that I don’t know- but that’s not important- I’m the boss, I give orders- and therefore I treat her like a second-class citizen. Who says that you have the right to do this? My own opinion- the patient gets well or dies not so much because of me but because of the nurses on the ward- I see the patient once a day- the nurses are there; they are there all the time- they keep the patient comfortable –they feed him, talk to him. You go on a ward where the nursing staff are working as a team together with their doctors- that word, the patients there will have a much better chance of recovery- I won’t say that you have to be healthy to be in a hospital- these poor people are ill- no medication in the world that doesn’t have a side effect. Placebo- you know that people have died on placebo. There’s one kind of medication where you can give as much overdose as you like- it’s called TLC- Tender Loving Care. You don’t have the time to do it but the nurses do- you should treat them as equals. And the payment you get back from them is over and above- I learned this when I ran my ward. I learned that the way to make a cohesive ward where things run like clockwork is to be good to the nurses- to treat them as equals- share medical knowledge with them, not teach them, but share with them- as an equal. Same thing with students- who are students, the lowest of the low- no! You’re a human being! And you’re no better a human being than me. Those students are one day going to be doctors- when you are too old to be doctors, they are going to treat patients the way you treated patients- because most of our learning comes through osmosis. I never in my whole life taught halakha to my staff- I never told my staff this is the way you have to run the ward halakhically- and yet my second-in-command who was a Jew in name only- he was an Israeli; he kept nothing. And yet when I was away, he would give me a run-down of the time I came back- medically and problems that arose on the ward- I never had to question halakhically what he did. I told him what to do- he saw what I did. And that’s better than giving orders. Please don’t think that I am patting myself on the back- I don’t have a back to pat. You have to realize that being a Jewish doctor is a full-time job- that’s what makes us an Am Hanivchar.

Examining a patient- let’s forget male patients and consider female patients. The patient has, by the nature of things, to bare herself when you examine her- her chest, her breast, her abdomen- you examine vaginal examination, depending on who and what kind of doctor you are. The patient is not some kind of animal or doll that you can play around with- and even if that patient walks in half-clad, that does not give you the right to not give her the respect you would give your own sister or mother. How would you like a doctor to examine her the way you examine your patients? This has to do with the halakha of tznius- shows how you are a frum doctor, halakhicist doctor.

An example- you have to examine the breast of a woman. You have to look at both breasts to see if they are symmetrical or not- standing on right-hand side of the patient so you examine the right breast. Give me one good reason why the left breast has to be left bare while you examine the right breast. Because you forgot? Because she’s just nobody? Would you want your mother or sister to be examined this way? So why should this woman, even if she is a goy- even if she doesn’t have self-respect, even if she comes in half-clad- you have to have respect for her simply because she is a human being!

You go down to the abdomen- you have to leave her half-clad while you examine the abdomen? Don’t think about this- make it so routine that you don’t have to think about; you do it automatically. That makes you stand out between your friend and comrade who is working on the wards- that woman will go around the wards and spread the word “You know who examined me? A human being. A man- a woman- who cared for me. Who cared for me even though I don’t care for myself.”

We doctors have been taught to use our hands, our eyes, our ears- most of us haven’t been taught to use our mouths. You have to talk to a patient. You have to listen to a patient. I know there’s no time! But believe me you’ll find so many doctors standing in the corridor talking to each other about narrishkeit, football games. On the street you believe that we are dealing with pikuach nefesh all the day- a lot of nonsense! Most of my time is doing paperwork- yours will be as well. So do the paperwork! So you ahe to talk shop…fine, so talk shop! You have an interesting case, you want to talk to your friend- but you want to know what was on the news yesterday? What has that to do with medicine? Instead of doing that you should be with your patient talking to him or her- the world of good it does to have a patient realize he has a human being treating him does more than any medication. Mechallel Shabbos- allows you to eat on Yom Kippur- the difference between eating on Yom Kippur- shiurim for instance. I’ll tell you a story- not a story, a halakha-I’ll tell you a story- not a story, a halakha- learned from Rav Auerbach, he paskened for 30 years that a kezayit is 30 grams. You ate a kezayit of issur, you’re chayav malkos. But my Rebbe, R’ Neuwirth shlita, author of Shemiras Shabbos k’Hilchata, was writing Chelek Gimmel, which came out 15 years ago, plus/ minus. So I used to drive him to R’ Auerbach and we used to sit there for an hour, two hours discussing Shermiras Shabbos K’Hilchata. They talked in Rashei Taivos and I didn’t quite understand what they were talking about- I was the driver- and driving back I drove back very slowly so I could ask what did you say. What did the Rav answer- so I got my payment for the gas I used up. So we started talking about shiurim and the Rav ztl said that 17 grams was a kezayit. So I saw my Rebbe- we both went into shock. So you know, I have a lot of chutzpah- if somebody says something to me and I think I don’t understand; I know I don’t understand- I’m not willing to take a psak, yes, no, mutar, assur- I want to know why. So I butted in and said to Rav tzl “Does the Rav make a bracha achrona on 17 grams?” He says “Vadai.” Silly question because Of how he just defined a kezayit. So I said “on leil seder, the Rav makes al akhilat matzah on 17 grams?” He said “Betach.” So I said to him “Does that mean that on Yom Kippur I only give my patients- up till now had been 40 grams- now I have to come down to 17 or 20 grams- that’s the maximum…” He answered me “Don’t play around with your patients!”

A kezayit changes on Yom Kippur? I know we are not talking a kezayit but a kotevet ha-gasah- on Yom Kippur it’s 40 grams, but all the shiurim are dependent on each other, it is a closed circle - it doesn’t make sense. But I realized I was on the red line if I hadn’t already crossed it so I kept quiet and went home so the Rav and I discussed it- baruch hashem what he didn’t understand, I didn’t understand. So I asked the Rav- “What’s the nafka minah- why should it change- here 30 grams, there 40 grams?” He said “Pashut.” All the other assurim are achilah- there’s no word achilah by Yom Kippur. There it says Innui. Innui has a different shiur! So Chazal knew difference between being absolutely hungry beause of fasting- and here- so the yetuvei daata allows you to be mechalel Yom Kippur. If it wasn’t that you could have 17 grams. So the psak he gave is that 40 grams remains 40 grams on Yom Kippur. But when it comes to matzah, you don’t’ have to take a whole great matzah and stuff it into your mouth and call Magen David Adom because you’ve choked.

RWozner says 20, R’ Elyashiv says 20…big difference between a whole matzah machine baked, which is about 32 grams, and eating half of it or just over half of it- so you see talking to a patient, empathy with a patient- not just taking a history; that’s businesslike. Talking to him, understand his needs and problems- things that you won't write in the notes, necessarily- makes you a friend of the patient. You’re not just his doctor- you’re someone who cares for him! I think that is one of the hallmarks of the Jewish soul- neshama of a Jew who reaches out to another human being.

I’m now going to say something which will make me lose friends and – I’m going to talk about Shabbos. I’m going to say things which may hurt you but I’m going to say it because just as you and I have a chiyuv to keep Shabbos, I have a chiyuv to scream when something hurts me. And it hurts me- it’s been hurting me for years- so I’m talking to the new generation who are becoming doctors. You’ve chosen to become doctors- that’s your choice- and I’ll go along with that- but I do not think you have chosen to become Mechalelei Shabbos. I want to go to your home and will be able to drink your wine-

When you drive on Shabbos to the hospital, your children have to be proud of you because you are driving to save a Jewish life that needs to be saved now, not in 10 minutes from now when I would get there if I walked. I drive on Shabbos to get there right now.I drive on Shabbos- I’m not ashamed to admit it.

Chillul Shabbos is permitted only in a situation of pikuach nefesh and safek pikuach nefesh- so I have a man here who has just come in, has acute myocardial infarction (heart attack)- no question that this is a situation of someone pikuach nefesh- so you have to pull out all the stops. I learned this from R’ Auerbach- the Gemara and the poskim say that Shabbos is dechuyah- Shabbos is not Shabbos. Either while you are writing for this patient, operating for this patient, and especially for the Ashkenazim who are sitting here- you have to go looking for a goy, shinui. I don’t have that problem- I’m Sefardi and have the Shulchan Aruch to rely on- no need for a goy or a shinui [the SA permits doing actions normally lekhat’hilah for a holeh she-yesh bo sakkanah, whereas the Rama requires using a non-Jew or at least a shinui if it will have no effect on patient outcome]. But since I don’t want people to say I look like a shaigetz I act like an ashkenazi.

Now this patient also has diabetes- you have to write out a diet sheet- will he die because he got that wrong food? It doesn’t matter if you write it with your right foot, or left hand to write it out- it is assur. However, ifa man is Shomer Shabbos- if he says “I could just do with a cup of tea”- but no hot water available- can I wake up the neighbor to get hot water from him? No, he is sleeping and has no hiyyuv pikuach nefesh. But it is on you- so boil water. I’ve never heard of tea curing anyone- but this is permitted because the patient thinks that it will make him feel stronger or more awake.

But a diet sheet for diabetes- I’ve never known a diabetic to die from this- most diabetics cheat anyway, most of them steal this soda and that cookie and that there- so what is the heter for writing a diet sheet on Shabbos? you’re only an intern- and the big resident says to you “You right that diet sheet or don’t come in tomorrow.” So you write with your right leg or your left hand. And you’re going to tell me that you’re going to stand up to this- you have the strength to stand up to a great big man looking down on you- oh yes, sitting here you can say I won’t do it- when you’re there, on the spot…you know, I once heard this from a friend- a relative of his went through the Israeli army- and he is now a teacher- and all these guys get in- to get chosen for the Parachute Brigade, courageous isn’t the word- supercourageous to get here, going to destroy a million Arabs- first jump you have to push them all out of the plane; they won’t jump.

I think that 99% of people in this room and in any other room would be mechallel shabbos when choice between losing your job and being mechallel shabbos- you’re going to say you once heard from a doctor it’s all right- who is this doctor- no one knows his name.

Private practice- someone rings you up on Shabbos where he has an ingrown toenail- so what are you going to do, you don’t want to throw away the patient- you can find an excuse, fool yourself- but can’t fool another doctor.

So after you have spent four precious years of your life to become a doctor and you are not in a Shomrei-Shabbos program. So what are you going to say- I made a mistake, I’ll become a bank clerk now. There aren’t any Shomrei-Shabbos programs in fields outside internal medicine. Certainly not formal ones, official ones.

Something else I have to say. How many young doctors know enough about medical halakha that they can make on the spot decisions? I do not know how to work on Shabbos without having a Shabbos goy as my shadow- I’m not talking about wring diet sheets- I’m talking about things that have to be done but that are not strictly saving the patient’s life- write with my left hand; it will take me a year to write like this! There are certain things I don’t know how to do without a goy- now you’ll say there’s plenty of goyim here- ladies nad gentlemen, I have had the tremendous zechut to speak to doctors- I spoke to a doctor once in Chicago- I was davening mincha and he came up to him- he said “You’re doctor Abraham?” I sai d”Yes; I don’t owe you any money.” He said “I just want you to know that I don’t work on Shabbos anymore.” He said that he does Sunday & Motzei Shabbos and they do Shabbos. How do you manage this? He says he pays him for the ballgame. He pays $200 twice a month to this goy plus exchanging shifts with this man- that is mesiras nefesh- he pays $200 a month and bought Olam Haba for himself.

There was a young lady in the audience; she came over to me and she started crying. I promise you I never touched her- she started crying. “What did I do to you?” She cried and cried before she could get a word out. She said “Do you really mean what you said? That I’m not allowed to work on Shabbos unless I am really saving a life?” I said yes- you really cannot work on Shabbos- the shogeg becomes a maizid, the ones becomes a muttar- she works in someplace in the Midwest- she works in a very, very hot department where there’s plenty of works and she works- she says “What am I supposed to do? I don’t know anything else?” Three or four years- she was arrested already. She was a single girl- “What am I going to do?” I said “I can’t help you. But you have to realize- if you’re crying over you- something is ticking inside you- Shabbos is talking to you.” So I went home, a couple of years later I come back and I’m told that that girl who was crying in the corridor- she gave up her job in the Midwest, came to New York, found a job here, got married, now has a kid and she is happy.

Ladies and gentlemen- would I do such a thing? Give up a job, a whole parnassah- these people are Tzaddikim! To give up a job, a parnassah, go somewhere she doesn’t know anyone- ladies and gentleman, you have nothing to give up yet. You are right at the beginning- please think about it, think about what you are going to do when that time comes- what if you don’t get into a Shomrei Shabbos program? Thank you.

*Thanking SOY, TAC, YSU and YC*

Questions and Answers:

GUY: Does the Rabbi have any advice for particularly a male doctor going into the field of OBGYN?

I spoke about this many, many years ago with R’ Neuwirth- author of Shemirah Shabbos K’Hilchata- number one, you should be married when you go into that profession and not single because pas b’salo- it makes things easier. And secondly if you behave as you should behave in your relationship with your patients, because all the patients by definition, or most of them anyway, will be of the opposite sex- you can be certain that not only physically but even medically you can keep away from the yetzer harah then you are doing a mitzvah, a big mitzvah. So if you’re not married- advice not to go into that field- first find a girl who is going to marry you. On a much smaller scale, you have same problem for us- but for you, it’s going to be your bread and butter- instead of seeing a woman once a week, you will see her once an hour- on the other hand, the yetzer harah is there- and just because you’ve been in practice for 10 years, yetzer harah is still strong- if you are certain that you are able to work lsheim shamayim and only lsheim shamayim and keep your mind and thoughts where they ought to be- concentrated on patient, situation and what you can do for her- tavo alecha bracha.

GUY: In terms of your last point, are you saying students should pursue other careers or plan better?

If going to do career, only one that has a mitzvah attached to it and a big mitzvah attached to it- but on other hand, end up four years later in a place where not Shomer Shabbos program- and before you know where you are you become a Mechallel Shabbos every single Shabbos. I can’t answer that because you have to look at yourself- look inside yourself and see what you are willing to sacrifice- but if you can withstand that- incidentally, to my great pain, things aren’t much better in Israel. Although the statistics there are different from here- all the time I’m talking about Jewish patients- Jewish patients who are sakanot nefashot- someone fell out of bed and he’s perfectl fine and it is Shabbos- they won't allow you to wait- that form has to be filled out within 24 hours. You know it’s pure paperwork- how are you going to fill out that form? If you think that you cannot withstand this in a sutaiont which is not conducive to Shabbos, then you have a problem. My own feeling is become a doctor, do the mitzvah of pikuach nefesh- save Jewish lives but don’t lose yours while you are doing that.

GUY: How does yichud apply to a patient-doctor relationship in the hospital?

I thought you were giving me an easy time when I came here.

Yichud is a problem from morning to night no matter where you are, what you are. and most people don’t know this- nothing to do with being a doctor. All sorts of situations which we take for granted where there is an issur d’oraisa of yichud. When examining patients, easier in hospital setting- door may be closed, but not necessarily locked- secretary, nurse, another patient by mistake- that door is in fact open, even though it is closed. If you can have someone in that room- nothing to do with halakha but to do with your pocket, with money- when that patient sues you for doing something you shouldn’t have done when you are completely innocent- it’s not stories, it’s happened. You should have a witness when examining a female patient. Private practice- seeing a patient in an office- can also be a problem. But again, if the door is closed and not locked- and even more so if other patients can walk in- not a problem. If the last patient is a female patient and door is closed but not locked but outside door is locked that is yichud- and there is no shiur to yichud. Let’s say five minutes- if when you start yichud, first second- good possibility that you won’t be interrupted for five minutes- so then in that first second you are “over” on yichud-

GUY: How does the Rav feel about gramaphones and disappearing ink?

When the first grampahone came into Israel and they were talking about disappearing ink- when the grampahone came out- I phoned R’ Auerbach- at that time for my sins, in addition to my normal work I was also looking after ICU. I thought this was a good opportunity to see R’ Auerbach- I should buy a gramophone- I called him up and I said- and he said “Why do you want a gramophone?” I said “Well people phone me.” He said “What, people invite you for a cup of tea on Shabbos?” I said no, but sometimes there are wrong numbers. He said how many wrong numbers do you get. I said one maybe once in a blue moon- he said, what do you need a grampahone for- pick up the phone b’shinui and finish-

Idea of disappearing ink- you can photocopy it before it disappears. Solved the problem for two days, but Rosh Hashana is three days in Israel- at beginning, produce these pens- first comment was “You want to write me a check with one of these pens?” and second one was “Ba’al Tashchit-“ when you write, you write with left hand and that is the end of

GUY: Question of pikuach nefesh for Non-Jews

We had 40 beds or so- and I took non-Jews. I never examined the tzitziyot of my patient. Does that answer your question?

Eivah- Tosfot in Avodah Zarah says- reshut eivah only works on a weekend, not on Shabbos. The fact that we use it to work on Shabbos is only a b’dieved- this I have heard from all the goyim. I am already working in a ____ situation. But going back to original thought- who says you have to be a doctor? I’m l’khatchila going to be a doctor here where the majority of patients are b’shum eivah- and what’s the heter to do that? That makes the problem. In other words, again, if you’re going into a Shomer Shabbos program- likelihood is that this is so because there are many Jewish patients. B’shum eivah is something that involves pikuach nefesh. On the other hand, also a b’dieved heter- not

GUY: Can you make another Jew take the call for you on Shabbos?

You’re okay- you live in America. R’ Moshe paskened it’s okay- you’re allowed to change your duty with a non-frum Jew. R’ Auerbach, poskim in Israel, said no- you’re only allowed to change with a goy. He too must keep Shabbos- you’re not allowed to change with another Jew so that you can keep your Shabbos.

The girls have no questions, I gather- everything is fine. The guys should learn from the girls.

GUY: Women doctors wearing Scrub pants or a headcovering in a sterile environemtn- I was wondering halakhically-

By us, the caps that they wear- they can cover the hair completely. So the married woman who would normally wear a heaadcovering can still scrub up – but you’re right, this is a problem.

GUY: What about a frum Jew who got a teshuvah from his Rav that he can work on Shabbos?

That his problem- but your problem is that you got a teshuvah from your Rav that you can’t work on Shabbos!

GUY: [not sure what]

There are only four hospitals to the best of my knowledge, in Israel, that run a Shomer Shabbos program- there are Shabbos guys- of those four, only two have accredidation- so therefore you can’t get your boards in the other two, so you are wasting your time. So in every other hospital you have to be mechallel Shabbos- so if you do come to Eretz Yisrael, and I advise you all to come before you are driven out to come to Eretz Yisrael, come here to greet the Mashiach- not enough to come to Eretz Yisrael, have to work there, be productive there- so come, come, come- we’re waiting for you.

GUY: Which two hospitals are they?

Sha’arei Tzedek and Bikkur Choim. The two Hadassahs have never heard of goyim- there are no Shabbos Goys there.

ME: (I was listening so didn’t type it)

GIRL: When you said before about what R’ Auerbach says about studying on Shabbos- any difference between a resident and a licensed physician- if the resident is still studying for boards-

No, because while he is studying he is treating patients. Any physician- even as an intern- usually first guy to see that patient. If that patient codes, first guy to put his hands on his chest. And therefore for him to study medicine is according to R’ Auerbach a mitzvah.

Thank you very much.


Anonymous said...

As an Orthodox (board certified)healthcare professional I found certain concepts presented in this lecture questionable. For example, there are situations when a physician must look at a woman's both breasts at the same time in order to observe the degree of marked assymetry. Pushing the concept of examining one breast while the other one is covered (and erroniously basing it on tzniut) doesn't work in this case.

I also was surprised by the doctor's approach to diabetics. I find it condescending and inappropriate to assume a diabetic cheats and that a diet order can therefore wait. The implementation of the concept of DO NO HARM to the patient must be a # 1 PRIORITY at all times and it doesn't matter whether a person is a medical student,intern,resident and etc.

If a man decides to be an MD-he should be allowed to follow his dreams. There is no reason to belittle people's ability and state that a man is allowed to become a doctor since he is not able to study Torah "16 hours/day". To each his own. Yes,it's much harder to be a shomer shabbat Jew in a NON- shomer shabbat medical/nursing programs. However,some of us are GIFTED HEALERS and it's possible to go through the programs and not violate the laws of shabbat(I'm a living proof of that as are many others).

As far as a man who wishes to become an OB/GYN specialist..... It's being suggested in this lecture that it's better if this man is married. But why? Because there is a chance that he will not be able to control his urges? Why assume the negative? Can't one be responsible and accountable for his own behavior?

I happen to believe that it's OK to wear scrubs if one is a female RN. Better scrubs than being exposed to body fluids contaminated with AIDS/Hep B and etc. It's so much easier to change soiled scrubs than a skirt,a blouse,pantyhose and etc. Besides,many Rabbis are willing to grant a female RN a psak allowing wearing of the scrubs these days. Why not take it and protect oneself from harm?

Last but not least-those of you who wish to read a truly fantastic manual that deals with medicine and hilchot shabbat-please locate a book titled HALAKHA and MEDICINE(A physician's hospital manual/hilchot shabbat) by Binyomin Sokol,M.D.(Regensberg Institute publishers/Jerusalem). You will find the content rather useful and refreshing.

Chana said...


Rock on! I agree with every single one of your points. You are my hero.

rivkayael said...

I find this extrmely problematic. Don't know where to begin but...

The scrubs = problematic issue for women. I think it is even more problematic to wear a floor sweeping skirt and run the risk of injuring yourself and your patients.

Context wise: I am a certified EMT who also works in a medical setting. Had a very "interesting" discussion with an instructor who was shocked that I identify as Orthodox because I wear scrub/EMT pants to training and ER work. She apparently had had arguments with Orthodox women EMTs who insisted on wearing skirts on the ambulances (leaping on and off with oxygen tanks and risks of getting caught in equipment and such). She ended up telling them to get off.

I don't understand how some chumrot can be allowed to override one's safety or the safety of one's patients.

Agreed with anonymous on all other points.

Anonymous said...

It is difficult to respond to somebody not willing to give his or her name to their comments, but a response is certainly in order to the first Anonymous's remarks.

It might be helpful to listen to the actual recording (Chana could perhaps link to it when it goes up) before you come to incorrect conclusions.

1. Dr. Avraham never indicated that there is never any reason to examine both breasts of a woman simultaneously. It was explicitly stated that after a doctor examines a women for assymetry, there is often no need for a women to be unnecessarily exposed for the rest of the exam. This was clear and your remarks are unecessary.

2. Let's just assume for a moment that Dr. Avraham knows many diabeteics and has treated hundreds if not thousands of such patients. This is is experience, you are free to disagree. Moreover, in his professional medical opinion (you are free to disagree) that eating a normal meal for all or part of Shabbat will not create pikuach nefesh. You can argue medically, but since we don't really know who you are, I find no reason to trust you over him.

3. "Yes,it's much harder to be a shomer shabbat Jew in a NON- shomer shabbat medical/nursing programs. However,some of us are GIFTED HEALERS and it's possible to go through the programs and not violate the laws of shabbat(I'm a living proof of that as are many others)."
Did you not write dietary orders? Ever sign any documents? Did that treat a patient? Ever log in to a computer? Type anything on a computer? Fill out an accident report?
Dr. Avraham quoted R. Auerbach and R. Neuwirth that no patient ever benefited directly in any way from any of these actions. Therefore, R. Auerbach concluded that these actions are absolutely prohibited on Shabbat. R. Hershel Schachter paskins similarly, and I have never heard anybody of stature disagree.
Oh, and being a "GIFTED HEALER" does not grant you any dispensation.

4. About a man being an OB/Gyn: I guess R. Neuwirth is just being a lot more realistic than you are. I think anybody reading this, would agree. Everybody has a yetzer hara, regardless of what they write anonymously on comments to a blog.

5. "I happen to believe that it's OK to wear scrubs if one is a female RN." Good, next time I have a halakhic shailah I will ask an anonymous commenter to a Jewish blog. This is patently ridiculous.
Nobody said a girl should wear such a long skirt that it causes problems - in fact, Dr. Avraham didn't actually address this point. I know of many girls who are just as makpid about tzeniut as they are about their patient's health. They manage just fine.
"many Rabbis are willing to grant a female RN a psak allowing wearing of the scrubs these days. Why not take it and protect oneself from harm?" Many 'rabbis' are willing to say you don't have to keep Shabbos at all, or kashrut or taharat hamishpachah for that matter.
Dr. Avraham limited his remarks to Orthodox doctors, assuming that they are consulting Orthodox physicians. He thought that went unsaid.

PsychoToddler said...

I wish I had time to write a proper response to this. I own Rabbi Abraham's book (in English) and find it useful for some things.

I think that we agree that it's really not possible to be on call on shabbos and parse each and every action to see if it fits within halacha or to do shinuyim. It's just not practical and leads to poor patient care. I also agree that there is quite a bit that has to be done on shabbos that is far from the category of pikuach nefesh. I can certainly verify this to be true. Again, you cannot parse these things, because while you are busy screening calls, you can miss something very important.

His solution, if I get the nub of your gist, is either not to take call on shabbos (even if this means you can't be a doctor after all) or hire a goy to do your bidding.

I can tell you that the latter is not financially feasible for most of us involved in primary care. It is common for specialists and surgeons, though, to have PAs or Nurses do all their documentation. But the system is not set up for primary care in this country for that to be viable.

As for finding shomer shabbos positions. Good luck. I was fortunate enough to go to Einstein where you don't have to take shabbos call, and afterwards I made a shomer shabbos residency for myself in the Midwest.

While that solved many problems, it created others. Foremost is that it doesn't prepare you for the real world, where you may find that many places will not want to hire you if you refuse to work on shabbos. And while you're going from practice to practice and being shown the door in each, be aware of the tremendous chillul Hashem that you may be generating, not only with the non-Jews you interview with, but certainly with the non-Observant Jews who will now have yet another reason to be hostile to Orthodox Jews in general.

Finally, and I really don't have time to express this well now, I don't think there is such a thing as taking a time-out from being a doctor. Even when I was in a shomer shabbos position, I worked on shabbos all the time. My office was the shul, or my house, or the rabbi's house, and people were CONSTANTLY asking me to be mechallel shabbos to do things for them. An antibiotic for this guy. Look in this one's mouth. Do some first aide for my kid who fell off the couch. In fact, the first time I drove on shabbos, it was to take a fellow shul member to the hospital. It was Rosh Hashana, in fact.

So if you're a doctor, you're always a doctor, there's no escaping it. And I think there is a value to having a frum doctor who takes care of people on shabbos. Many reasons. First, it's necessary if you want to be able to practice the other six days of the week, unless you're one of the lucky few who can finagle it otherwise. Second, because your patients deserve a full time doctor. They need to feel confident in you and your abilities, and shouldn't be afraid to call you when they are really sick. You're no good to them if you're "occupado" when they really need you. And finally, because it sends a message to the medical community, to non-observant doctors, and to the world in general, when they see a guy with a yarmulke taking care of the sick on shabbos.

It says, here is a religion where they care about life, so much so, that they are willing to put aside their most sacred rituals to save one. It is a tremendous kiddush hashem.

I agree with his other comments regarding tznius and the unique role of visibly orthodox doctor in the hospital and clinics. Consciously or otherwise, I do try to incorporate those behaviours into my own practice, whether it's the way I address nurses or assistants, or the care I give to ensure confidentiality and privacy to my patients, or the time I take to listen to them. I try to make them feel that they are important to me, and that I care about them, and that my goal is to make them feel better. All the more so because I have that black beanie on my head.

Mrs. Balabusta said...

As an orthodox nurse in a metropolitan pediatric hospital I would like to address the issue of dress.

Many ambulatory clinics allow street clothes. Others require scrub attire, but you must purchase, and launder your own. In this situation, I see no difference between street clothes and scrubs, since they both come from my closet and go in my machine. It is purely for the way the office personnel look. Most floor nurses also have to wear their own scrubs, except in the ICU. I have several scrub skirts and white skirts that are knee length that I wear to work, and I always wear full stockings or hose.

I am the only nurse in this hospital that wears a white skirt. It went out with the advent of penicillin. Still there is something to be said for sticking to your principals.

In the one clinic where I sedate babies and get spit and gagged on constantly I do wear a topper over my scrubs for exactly the reasons stated.

When I teach CPR I also wear a skirt, although a little longer. The getting down on the floor is tricky, but as long as they let you wear a skirt, I do.

I think I would feel ridiculous walking around in short sleeves and pants and a sheitl.

Anonymous said...

To Psychotoddler:
I don't know what you mean by: "First, it's necessary if you want to be able to practice the other six days of the week, unless you're one of the lucky few who can finagle it otherwise."
Do you mean that if you don't work on Shabbos than practically you will not have a job for the other six days? It sounds like that is what you mean.
If that is true, then there are plenty of jobs for the other six days - outside of medicine.
There is absolutely no heter to work on Shabbos so that you can keep you job the other six days. There are many jobs out there, you need not pick this one.

Anonymous said...


While I do wish to retain my anonymity on line, I will be happy to tell you who I am offline if that is what you wish. I have notified Chana who I am; you can follow up with her if you wish to contact me. I am an RN and a CDE, with many years of maternal child experience.

1. “Dr. Avraham never indicated that there is never any reason to examine both breasts of a woman simultaneously.”

Here is a quote from Chana’s write-up: “You have to look at both breasts to see if they are symmetrical or not- standing on right-hand side of the patient so you examine the right breast. Give me one good reason why the left breast has to be left bare while you examine the right breast.”

I have done these exams; it is very difficult to check for asymmetry without exposing both breasts at the same time.

2. “Let's just assume for a moment that Dr. Avraham knows many diabetics and has treated hundreds if not thousands of such patients. This is experience, you are free to disagree.”

Thank you, but as a CDE, I also have treated thousands of such patients. And yes, I have seen cases where eating a ‘normal’ meal for all or part of shabbos can lead to pikuach nefesh situations. I know of two elderly Jewish patients who entered DKA after having a ‘normal’ meal at a hospital. (I can explain offline if you wish to know the specifics.) The ‘normal’ meal spiked their blood sugars up tremendously. Do you agree that DKA is a pikuach nefesh situation?

3. “Did you not write dietary orders? Ever sign any documents? Did that treat a patient? Ever log in to a computer? Type anything on a computer? Fill out an accident report?”

Not sure why this is relevant, but I never did any of these things on shabbos during my training or on the job. I once did have to switch jobs to avoid getting into some difficult halakhic situations.

Perhaps I wasn’t clear; my point in speaking about GIFTED HEALERS was to question the doctor’s opinion that everyone who can sit and learn go into Kollel rather than pursue a healthcare career. I believe everyone has a gift that is unique to them that should be developed. Doctors are not exempt from learning and can also grow into Talmidei Chachamim.

“Oh, and being a "GIFTED HEALER" does not grant you any dispensation.”

I truly find your sarcasm unnecessary and unbefitting a God fearing Jew or a doctor.

4. "About a man being an OB/Gyn: I guess R. Neuwirth is just being a lot more realistic than you are. I think anybody reading this, would agree. Everybody has a yetzer hara, regardless of what they write anonymously on comments to a blog".

Most doctors I worked with in the past with are professionals. I believe they are not sexually stimulated when working with female patients who are somewhat exposed. We'll have to agree to disagree.

5. "I happen to believe that it's OK to wear scrubs if one is a female RN." “Good, next time I have a halakhic shailah I will ask an anonymous commenter to a Jewish blog. This is patently ridiculous.
Nobody said a girl should wear such a long skirt that it causes problems”

As a maternal/child RN who worked in a low income area, I was constantly exposed to body fluids possibly contaminated with HIV/Hep B viruses. Many of my patients were high school dropouts on drugs. Rabbi Gedaliah Dov Schwartz, the head of the CRC Beis Din gave me the psak that I could wear scrubs. See if you don't know of Rabbi Schwartz.

Again, I find your comment condescending and inappropriate. I hope you are more sensitive to your patients, nurses and colleagues.

Anonymous said...

To Anonymous,

I sincerely apologize for how my remarks sounded. I was responding to what, I and others, saw as an inappropriate brash tone in your initial remarks.
I am both happy that we were incorrect in reading your initial piece and somewhat embarrassed to have not been more generous in being dan le-kaf zekhut. It is something that I must continue to work on.

Anonymous said...

apology accepted.

May a peaceful Sabbath be upon you!

Anonymous said...

All these religious nutjob rabbis really need to cool it with the criticism of frum doctors. I am not a doctor myself, but I definitely recognize the importance of having frum doctors within a community. Pikuach nefesh doesn’t exist in a vacuum. One needs to train in order to be in the position to save lives. I have no problem saying that these rabbis are straight up fools for possibly discouraging talented individuals from becoming doctors. They are causing more harm than good, just to feed into their insatiable religious zealotry.

Although there may be exceptions, 95% of residence/doctors need to be mechalel shabbos for non-life saving purposes. But at the end of the day, it allows them to do more good and help more jews than any of these rabbis can ever dream of.

Anonymous said...

Dr. Avraham's point is not that we don't need frum doctors. We certainly do. But he is pretty adamant that we need frum doctors - not those who are moreh heter to themselves, but those who follow halakhah meticulously.
The answer is NOT for frum Jews to stop becoming doctors. Rather, Dr. Avraham has tried repeatedly to try to get national Jewish organizations involved in pushing for shomer shabbos residencies.
All the rabbonim "in charge" of all of these organizations agree - from R. Hershel Schachter, R. Yisrael Belsky, the OU administration to R. Perlow (Novominsker Rebbe), R. Shmuel Kaminetsky and more.
For whatever reason (feel free to speculate without violating any issurim), the organizations have not come through.
Any suggestions?

Anonymous said...

I cannot trust the halakhic authority of someone who states as a medical fact that most diabetics cheat.

Charlie Hall said...

Happy birthday, Chana!

And thank you for these great notes.

Shmuel said...

I know it's an old post, but in case anyone like myself has just stumbled upon this wife is completing clinical rotations as a medical student here in Eretz Yisroel. While we dealt with many objections, we had properly tzanu (we're not talking about silly pencil skirts either, calf to floor length, wide enough to flow, and scrub pants under during surgery or stockings during other rotations , and properly professional scrub skirts. For some hospitals we had xxxL scrub pants altered, and other times we were able to contact the hospital's uniform provider and buy a few meters of the same fabric to make proper skirts.

Yes it was an uphill battle every time, and US rotations and residency probably won't be easier, but as Rav Dr. Avraham said, if you want to be a doctor, the goal is to be a FRUM doctor.

We don't get challenges and nisyanos we can't handle, if you want to know what to do, "The shchina rests in the daled amos of halacha" (Devine presence rests in your own personal 'four-square' of following Jewish Law).