Wednesday, June 07, 2006

Shabbat observance during the clinical portion of medical school

I was wondering what the NMHS membership thought about shabbat observance during the clinical portion of medical school.

The only explicit responsa that I have read on this matter is Dr. Rosner's short piece in Practical Medical Halacha, where he writes that a medical student is obligated to work in the clinics on Shabbat provided that he does not transgress any melacha, be it biblical or rabbinic. He bases this on the concept that once a Jew decides to pursue medicine, he must educate himself to the best of his ability.

Based on this essay, it seems that a medical student should not be allowed to do any melocho while doing his primary required 3rd year clerkships because his responsibilities are purely educational. Is everyone in aggreement then that a medical student should be allowed to do melocho while doing his sub-internships, when he has patient care responsibilities?

Additionally, I would like to raise the possible distinction between 3rd year experiences where the student has patient care responsibilities versus those experiences that are purely educational. For example, at my medical school, the medical student has no primary responsibilites while on the Internal Medicine clerkship. The intern and Sub-I on the team are collecting all of the same information that the medical student collects.

On the Surgery rotation, the medical student is solely responsible to record the vital signs and i/o's every morning. I think that it is reasonable that a medical should be allowed to do at least melocho d'rabbanan while on Surgery, but not while on Medicine.

I would love to hear comments on this matter.

David Wise

6 Comments:

At 12:21 AM, Anonymous Anonymous said...

there are several aspects to this question. A) there is not necessarily agreement as to what are the nature of different melakot, drabanan, etc
B) there a differnce of opinion regarding the permissibilty of getting into a situation and what to do once one is in the situation
C) what are the details of what you are doing? are you going to be able to do drabbanon and not deorisas?
it is very easy to say you can do anything as long as you are not doing an avaray but what does that mean in the practical sense.
What is rosner saying, the med student can show and do what?? how does he/she get to the building , get to the clinic and then just sit around while fellow students are being put to work/ scutted?? get real.
in your surgery case you can argue that you are writing with a shenoy but is each pt a pechuach nefesh or what, does it matter if the patient is a lo-yhudi, and can you refuse to write the d/c note or argue that d/cing a pt is pechuach nefesh??

 
At 2:28 AM, Blogger Avi Oppenheimer said...

Regarding a sub-internship: At Albert Einstein they will accomidate students with a pre-arranged Shomer-Shabbos sub-internship (no switching necessary). Out of curiousity (and interest for pre-med students) what is the experience at other US medical schools? Do you have to work on shabbos? Make your own switches?

 
At 9:51 PM, Anonymous Anonymous said...

David,

I have some trouble with your idea that during sub-internships a student may be allowed to do melacha.

I would like to be enlightened on this. (I would ask my wife, but I don't want to get into a shalom bayit problem.) The student is carrying out some medical tasks, but my understanding is that s/he is not actually the responsible or decision making party, *and* that the student's role is not essential to the patient's care (ie; if no student were available, the patient would still receive the same competent care).

If my understanding is correct, how then do we allow violation of Shabbat/Yom Tov?

When I did clinical rotations as a paramedic (OR time for intubations, L&D for simple deliveries, ER for working codes, etc.), I simply did not do clinicals on Shabbat or Yom Tov. Even though every intervention I did was relevant to pt. care, it could and would be done without a Jewish intern doing it.

The same was true when review labs were scheduled on Shabbatot before the National Registry exams. I simply couldn't be there.

Now, as a working flight medic (FP-C) and paramedic/training officer for a 24/7 regional service, I simply am not available on Shabbat or Yom Tov. I work that out before even taking the job, as I did during school and various advanced certification courses. The only 'exception' is that my wife and I will attend medical conferences on Shabbat, but of course without involving any violation of Shabbat.

Now I'm working on a BSN, and my approach is still the same. I will do anything necessarry to compensate the program or other students for my unavailability on Shabbat or Yom Tov, but I will not do my clinicals on those days.

I don't mean to be disrespectful or unsympathetic, but I don't understand where the heter is here.

Thanks.

(Rabbi) Mordechai Y. Scher
NREMT-P, MICP/PNICP, FP-C

married to Shulamit Yaarah (aka Sandra) Scher, MD
HSR-2, Los Alamos National Labs

 
At 11:48 AM, Anonymous Anonymous said...

I think there are 2 issues involved in Rabbi Scher discussion. One is the Halaka. A doctor has no special halaka. Each Jew has an obligation to help his fellow man in accordance with halaka. A physician may know more and therefore can/ will do more but the halaka is the same. The second area is it a good idea psychologically for the individual / family to be away on Shabbas. As you wheter one wants to be working on shabbas. e.g in israel where the ratio of J to nonJ is greater. Someone has to be in the hospital to work. we need EMTs on shabbas. i have read that there is an issue of putting oneself into a position where one can relie on pekuah nefesh but then that really applies to the whole field of medicine esp. private practice where one is always on call. So there is no obligation for you to work on shabbas even if it is entirely permitted. But that does not mean that one needs to refrain from doing permitted malaka.

 
At 6:55 PM, Anonymous Michael Oppenheim, MD said...

I have some trouble with your idea that during sub-internships a student may be allowed to do melacha.

I would like to be enlightened on this. (I would ask my wife, but I don't want to get into a shalom bayit problem.) The student is carrying out some medical tasks, but my understanding is that s/he is not actually the responsible or decision making party, *and* that the student's role is not essential to the patient's care (ie; if no student were available, the patient would still receive the same competent care).


I personally don't think your first point, that the student is not actually the responsible or decision making party is a major factor. In general, interns and residents are technically not (final) decision makers either. Ultimately, there is a responsible attending physician. In practice, at many city/county facilities, the attending lema'aseh behaves more in a rubber stamp capacity, but that is actually not appropriate. Additionally, most of what students and housestaff are called upon to do, be it assessing a patient to then discuss with an attending, performing minor procedures, writing notes and orders, is an essential function independent of who actually is making 'decisions'.

Your second point, regarding the role of the student as a critical or superfluous team member, is more the critical feature which distinguishes the third year medical student 'clerk' and the subintern. A third year is an additional person on a team with a full complement of housestaff, while a subintern (or two subinterns) generally takes the place of an intern, and has all the responsibilities the intern would have had. History and physicals, procedures, etc. are his/her sole responsibility -- at least, as much as they would have been an interns. The major gray area is order writing, since subI orders need a cosignature, the order of the SubI may be seen as superfluous.

Note that this is the perspective from an attending of 10 years at teaching hospitals on Internal Medicine/Medicine Subspeciality services; surgical/obstetric programs may be different.

 
At 4:21 AM, Anonymous Anonymous said...

IMHO as a (non-observant) Jewish physician, if a medical student wishes to be shomer shabbos, they shouldnt be required to come into the hospital at all. They should leave the hospital early enough on Friday to get home before shabbos begins, and they should keep shabbos until it ends on Saturday.

This talk about the student needing to learn, or having a responsibility to his/her patients, is baloney.

It's not going to make a darn bit of difference to the student's education to have a day a week off, and frankly, medical students should have two full days a week off anyway.

Also they are STUDENTS. They are paying to receive an education. They are not being paid to work. There is no responsibility in the hospital that should require or rely upon them for proper functioning. If the medical student usually checks i/os on surgical patients in the morning, then when they're not there, the intern, resident, fellow, or attending will need to do it.

It's complete baloney that there would be any legitimate reason of any kind preventing a student from fully observing shabbos if they want to.

 

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