Horav Eliezer Waldenberg (Tzitz Eliezer) was asked to issue a halachic ruling concerning doctors in a teaching hospital, who, when making daily rounds, would be accompanied by any number of students. Is it permissible to teach the students under such circumstances in which the students having the information provides no benefit to the patient? In teaching, the doctor must reveal the patient’s illness and prognosis, when, in fact, it does nothing more than offer information to the students at the expense of the patient’s privacy. Is this a violation of the oath of confidentiality, doctor/patient privilege?
Rav Waldenberg rules that the oath is not an issue, because, when the doctor takes this oath, he has in mind the fact that he will one day teach students, and they will together visit patients whose details of their illness are vital to their being mentored. They cannot go into a room and begin to guess about the patient’s illness. Furthermore, a doctor, as well as any mentor, increases his personal knowledge when he is teaching. Teaching deepens one’s understanding and sharpens his knowledge through the process of explaining concepts and guiding others.
The Rav brings up another issue, however, which potentially undermines the doctor’s ability to mentor his students at the expense of the patient’s feelings. The pointing, poking and staring at a patient’s overt signs of illness, followed by a discussion concerning treatment and even prognosis, can do wonders to destroy a patient’s self-esteem. This is especially true if the illness affects parts of the body that are usually covered. Is this not an affront to the patient? Does teaching authorize the mentor to view the patient as a “subject,” rather than a person?
Rav Waldenberg rules based on the Netziv’s commentary to our opening pasuk. The Netziv quotes the Raavad in his commentary to Toras Kohanim, who explains that the word l’horos is to be understood as the imperative for the Kohen to teach. This means that, when the opportunity to examine a metzora arises, the Kohen should gather the younger, inexperienced Kohanim and instruct them in the process of determining the impurity of a plague. If they will not learn, they will not know how to rule when they must examine a metzora. This is why the Torah concludes with Zos Toras ha’tzaraas, “This is the law that applies to a metzora” – exclusively. We derive from here that the concept of teaching students – even at the expense of the patient’s feelings – applies only to a metzora and no other patient. Whatever shame the metzora feels is a part of his teshuvah process. Humiliation segues into regret. Embarrassment helps to mitigate and expiate the sin.
As such, concludes Rav Waldenberg, a physician teaching his students does not have the right to show the wounds or inflections on a patient’s body parts, without the patient’s express permission. He/she is not on display. If the patient expresses his negative feelings to being a part of a doctor’s show and tell – his wishes must be respected.
