Sunday, June 26, 2011

Should we go to the best doctor?

Last week R' Elyashiv had heart surgery and the Charedi press had extensive coverage. Mishpacha (Hebrew) had a number of articles about the surgery including a profile of the surgeon. They flew in the top cardiac/blood vessel surgeon from Cleveland (a religious Catholic) to do the surgery.

The question I would like to ask is why was that necessary? The prevalent (only?) Charedi hashkafa today is that not even a leaf falls without it being a גזירה מו שמים and that השתדלות has no effect, it is just an illusion. השתדלות is just so that we avoid ניסים גלוים (see מכתב מאליהו, חזון איש אמונה ובטחון and others). If so, shouldn't bringing the top surgeon be too much השתדלות and a lack of בטחון? After all, Hashem is doing the healing not the surgeon and once we have done our השתדלות, going to the doctor and having the surgery, why should it matter whether the surgeon is the best in the world or simply Joe surgeon who is competent? As long as we do our השתדלות to avoid requiring a נס, the rest is a גזירה מן השמים. If the גזירה is that the surgery will be successful, then it will be successful even if done by the average surgeon, and if the גזירה is that it won't be successful then it won't help that you have the best surgeon.

In fact, what does it actually mean that someone is considered the best surgeon? After all, הכל בידי שמים, our success is actually an illusion to make it look like it is our skill. In fact, our success in worldly matters is simply a גזירה מן השמים so the fact that he successfully operated is not due to his skill but due to the גזירה מן השמים.


Moshe said...

I fully agree with your analysis. After thinking about the situation for a while, I think that it might be that the type of surgery done (I have no idea what was done - the chareidi press does not give any details, probably due to lack of any basic medical knowledge) is not done in Israel due to lack of experience in the surgery. This is only a theory - I have no idea, and your analysis truly shows a bit of hypocrisy in the chareidi world.

bluke said...

That was my thought as well, although from all the reports I read it doesn't seem that the surgery was that complicated or unusual. I find it hard to believe that there was no doctor in Israel who could do teh surgery.

Moshe said...

After doing a few google searches, I came up with the following:
Dr. Daniel Clair is an expert in endovascular aneurysm repair. Rav Elyashiv had surgery on Motzaei Shabbat and left the hospital on Monday. There is no way in the world that he had open surgery - his hospital stay would have been weeks, not days. The surgery was probably some type of aneurysm repair which was done endovascularly.

This is a fairly new procedure, and there are probably not many doctors in Israel who can do it - if at all. People who have aneurysm repair in Israel will simply have regular surgery, which has higher mortality (about 5% vs 1.2%) and a far longer recuperation time. In the elderly (above 85), this is even a higher difference in mortality - about 8.5%. See here:

So in this case, it was probably the right call - to get a surgeon who has hundreds of these cases under his belt as opposed to a surgeon who has only done a few of them.

The question still remains - did he need Dr. Clair or could any surgeon with expertise in noninvasive repair have done the job? Don't know, but if we needed to import a surgeon, we might as well get the best.

bluke said...

Thanks for the information. However, the procedure seems to be performed in Israel. See

(4). Endovascular aortic aneurysms repair (evar) of infrarenal abdominal aortic aneurysms and aneurysms of the descending thoracic aorta.

joshua said...

the difference is simple. It's the same difference between major and minor surgery. It's minor when you haveit, major when I do.

Same here. While hishtadlus really is unhelpful and any good doctor would do, when I am having surgery, I am machmir on my hishtadlus and put in extra - typical, do as I say, not as i do.

Chana said...

Regarding the "best doctor" jazz--sometimes it's like going to the gadol hador to ask about sticking a meat spoon in a cup of hot milk--you would get just as good an answer, much faster, from your LOR.

And I have seen too many peopl, particularly haredim, fall into th trap of paying Sharap for the "best", when it means their total care package is less well-coordinated and, in practice, worse. The Big Honcho may not work in tandem with the regular ward staff, which will certainly make his response time in case of problems a lot slower, and will gum up the works by making the care program less efficient and less responsive to patient need.

The Big Doctor always gains when the patient pays extra for him, the patient, not so much.

bohr salino said...

I think it is just a matter of covering oneself. If the procedure failed they would be able to say that they chose the best specialist vailable and that they are not to blame.
Another point is that there is a difference between Hishtadlus for yourself and for somebody else. In this case the hishtadlus was not done by Rav Elyashiv but by his people.When you do Hishtadlus for somebody else you do the best.

Berel said...

The only time I have heard Chareidim downplay the importance of histadlus is when they feel it is coming at a major spiritual expense (e.g. leaving Yeshiva for college with no CURRENT financial pressure to do so)In a case of a medical emergency where there is no potential loss the chareidim are very in to histadlus with the mindset that ultimately histadlus makes little difference as only hashem determines what will happen.

bluke said...


That doesn't really make much sense. If hishtadlus makes little difference then why be in to hishtadlus? The answer I believe is that many people have little faith when it comes to their health.

Berel said...

If hishtadlus makes little difference then why be in to hishtadlus?

Because it is every persons obligation to make whatever effort they can.It is a Mitzvah to guard ones health, to make Parnossah (when needed)etc. Therefore we do a much effort as possible to fulfill these Mitzvohs prudently.But the ultimate outcome is solely Hashem's decision.

bluke said...

That is not what the Chovos Halevovos and many others say. According to them hishtadlus is basically a tax, and you should do the minimum that you can so that Hashem doesn't need to do a נס to save you.

SF2K01 said...

I'll step up an defend them here to a degree. Why would they need a huge authority when the minimum hishtadlus of getting a local doctor would do? Well, clearly that means the problem is much more severe than they're letting on. It's not a neis to require a top doctor for problem worthy of his attention; a lesser doctor wouldn't even be able to handle it. I doubt this guy would even agree to fly out if local doctors were capable.

In other words, in this case I think the minimum hishtadlus would in fact be to get the top doctor in the field. At least, this is true if they are being theologically consistent.