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the dangerously ill patient. If this wouldn’t work, because it would be 1 Question 3
a waste of precious time for physician A to understand the problems
of the two new patients, then physician B should have assistants to
help him deal with the workload. It is also likely that according to
Torah law the hospitals should put the interns on call during the day,
when they can consult with expert physicians, and assign more expe-
rienced residents to the night shift (with appropriate payment). It is a
great mitzvah for the administrators of the health agencies to improve
the working conditions of physicians, for the benefit of the patients.
One should also encourage the interns to consult with experts.
As our Sages said, (Berachos 4a) Dovid haMelech would consult with
his Rebbi, Mefiboshes, on every case that came before him. “Did I
judge properly?” he would ask him. Mefiboshes would then humiliate
Dovid in order to make him greater and to uplift him. This will be the
reward of a student who does not hold back from asking his teacher,
even during the night, if necessary.
Practically, since procedure currently dictates that the intern treat
the patient, if the intern can provide treatment, and will ask his su-
pervisor any questions that arise, then one should send the danger-
ously ill patient to him. However, if the physician in the emergency
department knows that the intern does not know how to properly
treat this difficult case and will not accurately present the problem to
his supervisor, then the emergency room physician is obligated to do
whatever he can to transfer the patient to physician B. It should be as
if there is no physician in unit A, and that the patient must be sent to
physician B no matter the cost.

Waking up the Expert Physician when there
is Another Good Physician in the Hospital
1 Question
An important public personality came to the hospital at night with
196 1 Medical-HalacHic Responsa of Rav ZilbeRstein
#
The doctor on duty in the emergency room knows that a patient will
receive much better care for his specific illness in another hospital.
1. Should he tell this to the patient?
2. What is the halacha if there is a possibility that people will find
out and then the physician is liable to lose his job?
1 Question 4
The Director of a clinic where there was a shortage of physicians hired
additional staff-members who are not yet expert physicians. When
they have to perform a complicated test, such as a bronchoscopy (the
insertion of a tube through the windpipe into the lung and the biopsy
of a piece of tissue in order to make a diagnosis), they ask one of 20818_efi-ab - 20818_park-C_efi-ab | 7 - B | 18-08-20 | 13:46:24 | SR:-- | Magenta #20818_efi-ab - 20818_park-C_efi-ab | 7 - B | 18-08-20 | 13:46:24 | SR:-
the expert physicians available, and if he agrees, then they rely on his
instructions to determine the outcome of the test. A bronchoscopy is
done only by an expert physician. It is accurate 90% of the time if the
performing doctor is an expert who knows the patient beforehand. If
he does the procedure without knowing the patient (as in this case,
where the patient is initially examined by the intern or resident) the
rate of accuracy decreases to 70%. The physicians who are not experts
err more often than the experts and until recently only experts would
examine the patients.
1. Is it permissible for a non-expert physician to examine the pa-
tients?
2. Do they have to tell the patients that they are not experts?
3. Does one have to publicize the fact that there are interns and
residents on staff?
4. Is the 20% deficit in the quality of the procedure permissible
according to halacha? (The procedure is very unpleasant, and
no patient would be willing to undergo it again.) Should every-
thing be done by an expert, even though the wait for the patients
Division of Work in Hospital 2 193