Slow Choices

Recently I read a wonderful article by Atul Gawande, author of  The Checklist Manifesto, in the New Yorker. In this piece Slow Ideas, he discusses how in the medical field some ideas spread quickly while other ones languish. One might assume with our highly networked digital world good ideas would spread seamlessly and evenly throughout the field. Evidently being informed about the best ideas is not enough to get people to change their habits. In his article he gives a lot of medical examples to prove this, but seeing that I am a Rabbi I will spare you all of the examples. One of the most telling factors that led to change in medical habits was the perception of causality. Where doctors could see the impact of anesthesia sedating the patient right away, they did not directly see the consequences of washing their hands. In the case of anesthesia the surgical experience changed right ways. They did not perceive a direct causal link between the infections caused by germs and their lack of sterile surgical practices. It is not that doctors were lazy or ill-willed, they just were slow to wash their hands because they did not see its impact.

I got to thinking about this article in the context of Re’eh, this week’s Torah portion. There we read:

See, I set before you this day a blessing and a curse: the blessing, if you shall hearken to the commandments of the Lord your God, which I command you this day;and the curse, if you shall not hearken to the commandments of the Lord your God, but turn aside, out of the way which I command you this day, to go after other gods, which you have not known. ( Deuteronomy 11: 26-28)

The Torah is asking us to see the impact of all of our choices. Sight is central to the human conception of causality. Before us are always choices to be made between blessings or curses. At the same time we are empowered to make choices we are held responsible for the consequences of these choices. The Torah does not leave open the possibility of a pareve , neutral, choice. We are being asked to have the vision to realize the consequences of all of our choices.

There in his article Atul Gawande wrote:

The key message to teach surgeons, it turned out, was not how to stop germs but how to think like a laboratory scientist. Young physicians from America and elsewhere who went to Germany to study with its surgical luminaries became fervent converts to their thinking and their standards. They returned as apostles not only for the use of antiseptic practice (to kill germs) but also for the much more exacting demands of aseptic practice (to prevent germs), such as wearing sterile gloves, gowns, hats, and masks. Proselytizing through their own students and colleagues, they finally spread the ideas worldwide. ( Slow Ideas)

I do not think this conception is limited to surgeons. If more of us saw our lives in the context  of a laboratory we would be seeking out evidence to evaluate all of the choices we make every day. But do not worry I am not about to hand in my Tallit for a lab coat. Gawande is pointing out that often it is not what we know, but who we know that makes the biggest impact. As he writes, ” We yearn for frictionless, technological solutions. But people talking to people is still the way that norms and standards change.” It is the people that we see that influence our habits.  What Gawande calls apostles, we call hassidim. While Gawande is focused on medical practices, the Torah is asking us to think about in regard to all of our practices. We need to develop communities of vision that empower us to see the positive impact each of us can have on the world and stay focused.


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