It's Not What you Know

Shabbat Achrei Mot Kedoshim 10 Iyyar 5767

It's not what you know; it's the diligence with which you apply it.

I recently heard a fascinating podcast by a Dr Atul Gawandi, who is a general surgeon at the Brigham and Women's Hospital in Boston and a prolific medical writer.

Gawandi's latest book is called "Better". Simply put, it's a thesis on how to do, what we do, better.

And it turns out that getting markedly better results has little to do with greater intelligence, more talent or better tools.

Applying greater diligence to what we do, paying more attention to detail, is what makes the real difference.

An example. Each year two million people leave US hospitals with bacterial infections that they didn't have when they went in. Of those 90,000 will die.

How can this shocking result be improved?

Says Dr Gawandi: It doesn't require the doctor to be a world expert in cleaning under nails, nor does it require him to scrub extra hard. It does however require him to wash every single time he has to. And if that amounts to 100 times a day, then he must wash 100 times a day. 100 times, not 90 times. Washing hands that many times a day is onerous. It's easy to understand why the medical practitioner may not be inclined to do so. But within his decision of whether or not to wash lie the seeds of life and death.

In the case of the individual patient, the doctor may never know the results of his decision. But statistics clearly indicate that hand-washing, something every mother tells her children to do, has a dramatic effect on life/death outcomes.

Gawandi then goes on to speak of Cystic Fibrosis. The US average survival for a person with cystic fibrosis was 33 years. There is a doctor in Minneapolis who achieved 47. The difference is mind-boggling. The centre in Minneapolis and the doctor concerned were using the same technology as everyone else. What could cause such a difference?

It turns out that many patients were simply not taking their medication! But with so much at stake, why not?

On any given day, the likelihood of having no symptoms without medication is 95%, whereas with medication the likelihood of not having symptoms is 99.95%. This is hardly world shattering, and therefore many people opt not to take the medication. But how does this small daily amount translate into life expectancy? Fourteen years! Phenomenal.

So it's not so much the know-how or the technology. It is the diligence in applying every detail of what we already know.

As Dr Gawandi points out – no generation in history has experienced the medical and technological breakthroughs that we have. Our challenge is bridging the gap between knowledge and implementation – bringing the theoretical breakthroughs to practical outcomes at the bedside.

The Baal Shem Tov says that from whatever we see or hear, there must be a lesson in our service of G-d. Looking after our health is of course a very important Mitzvah – one upon which all others are dependent.

But there are other lessons as well. How often do we think that as long as we know what's right and apply it most of the time – that's good enough? That our little lapses here and there are of no real import?

And in truth, on any given day we may not feel the affect of our carelessness. The problem is that all these little lapses eventually add up – and as in the above medical examples the result can be startling.

On the other hand, we ought also realize that when we do what we should, it's not a matter of "whatever". It's significant. You may not see the results of your diligence. But that extra thing you do may mean the difference in someone's life.

As in medicine, Judaism places a lot of emphasis on small things. Saying a blessing every time you eat, washing your hands each time you partake of bread, and many other such "small", "unimportant" things. Does G-d really care? – we ask ourselves. G-d certainly does care – but more important is the long term effect on ourselves and those who come after us. Of course we all feel really good and proud as Jews, and so we should. These global feelings are important, but as the environmentalists say: "Think Global; Act Local". The little things do count.

There is more Jewish knowledge available in the English language today than in any foreign language every in history. But, as with medicine, it's not enough for it to be in the books, or even in your head. It's the diligence in application that makes all the difference in how we will survive, how our grandchildren will survive, as Jews in the future.

As with medicine the small things of today may have huge ramifications tomorrow. A tomorrow that is not that far away.