Rafeinu: An Apple A Day

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September 13 2016

An apple a day keeps the doctor away may be more than just a folk saying. According to the Mishnah Kiddushin 4:14 [82a], it may be the greatest gift you could give your doctor! In the context of discussing various professions, the Mishnah states:

Rebbe Yehudah said in his name [Aba Gurion]: Most donkey drivers are wicked, most camel drivers are upright, most sailors are pious, the best of doctors go to hell, the upright amongst butchers are the partners of Amalek.

So, eat an apple and send your doctor out of business. Apparently, he will have reason to thank you in the next world! 

Jokes aside, it does seem as though there are some mixed feelings regarding doctors (1). In truth, Rebbe Yehudah's teaching isn't really a fundamental statement about all doctors. Rather, it expresses the pitfalls that a doctor with true expertise can run into - arrogance. This can happen in a variety of ways. Rashi explains that he isn't afraid of illness, it is something that he sees as being within his control. Additionally, there are times when he is reckless and kills his patient. Even worse, there are times when he doesn't heal someone when he knows that he won't receive compensation. Alternatively, R. Shmuel Eidels (Maharsha) writes that the doctor's expertise holds him back from asking the advice of his peers, leading him even further down the dangerous path of arrogance, at times precipitating the death of patients. 

This Mishnah provides a glimpse at what can go wrong in the religious world of a doctor. However, it doesn't give a complete picture as to how we are meant to view the whole enterprise of seeking medical care. Fortunately, there are a number of other statements found in the Gemara, including this one from Berachos 60a:

Rav Acha (2) said: One who goes to have blood let should say the following prayer, "May it be Your will, G-d my Lord, that this should bring me healing and that You should heal me for You are a faithful healer for Your healing is true." For it wasn't the way of mankind to heal, but they did anyway. Abayei said: A person shouldn't say this for it has been taught in the study hall of Rabbi Yishmael:   "he shall surely provide for his cure." From here we learn that a doctor has permission to heal. What should he say afterwards? Rav Acha said: Blessed is the One who heals without reason (3).

Much has been written analyzing the above statements (4), but the accepted approach amongst halachic authorities seems to be that we accept the prayer of Rav Acha (5) and the mentality of Abayei. We do assign great importance to doctors and many authorities don't mince their words when critiquing those who forgo seeking out medical attention. At the same time, we strive to maintain the correct spiritual mindset when engaging with medicine.

All of this can provide a fascinating perspective on one of the berachos from the Amidah, the berachah for healing - Rafeinu (6). By exploring the source of the wording used for this berachah and comparing it to the ideas above we can uncover what mindset it is conveying to us.

The text of the prayer as translated by R. Shimon Singer (7) is as follows:

Heal us, O Lord, and we shall be healed; save us and we shall be saved; for thou art our praise. Vouchsafe a perfect healing to all our wounds;{fr. *}  for thou, almighty King, art a faithful and merciful Physician. Blessed art thou, O Lord, who healest the sick of thy people Israel.

The opening words, "Heal us, O Lord, and we shall be healed" are borrowed from Yirmiyahu 17:14, where Yirmiyahu rebukes the Jewish people for not observing the Shemitta year (and a few other things as well). In its original form, this phrase is in the singular and has been altered to fit the plural language found in the Amidah. The rest of his speech makes it readily apparent what the Sages intended by utilizing Yirmiyahu's language:

5. So says the Lord: Cursed is the man who trusts in man and makes flesh his arm, and whose heart turns away from the Lord.

6. He shall be like a lone tree in the plain, and will not see when good comes, and will dwell on parched land in the desert, on salt-sodden soil that is not habitable.

7. Blessed is the man who trusts in the Lord; the Lord shall be his trust.

8. For he shall be like a tree planted by the water, and by a rivulet spreads its roots, and will not see when heat comes, and its leaves shall be green, and in the year of drought will not be anxious, neither shall it cease from bearing fruit.

9. The heart is deceitful above all things, and when it is sick, who will recognize it?

10. I, the Lord, search the heart, test the kidneys, to give everyone according to his ways, according to the fruit of his deeds.

The harsh attitude expressed toward those who trust in man is evocative of R. Acha's prayer quoted above and, as such, is at odds with Abayei's opinion that we have the Torah's permission to heal. Since Abayei's view is the one generally accepted by later authorities, what are we meant to learn from this berachah?

I believe the answer is really quite simple. Yes, we clearly accept Abayei's opinion and it guides our lives. However, this fact has a pitfall: forgetting that the doctor isn't truly in control, isn't really providing the healing completely on his own. G-d is the healer, the doctor is an indispensable messenger. As we stand before G-d, in the midst of the silent Amidah, we acknowledge this truth. It is perfect for the rarefied spiritual atmosphere of the Amidah and it is meant to seep into our worldview just enough that we don't lose sight of the true source of healing.


(1) For an interesting article that places this teaching in a modern discussion, see  http://journalofethics.ama-assn.org/2014/08/mnar1-1408.html

(2) I'm not entirely clear which Rav Acha this is. For now, I'm assuming, based on Abayei's language, that he is an earlier Rav Acha.

(3)"Rofeh Chinam." I've seen this translated as "Who heals for free." I don't have a proof that I'm correct, but I certainly think it makes more sense to praise G-d for healing even though we may lack the merit. 

(4) For example, see Shu"t Tzitz Eliezer 5 in Ramat Rachel 20-21, where this topic is discussed at length. Click here.

(5) See Shu"t Aseh Lecha Rav 3:31 who concludes a discussion of being paid to give medical care with a caution to remember where one's faith should be directed. He notes that the "ikkar - core" of one's trust should be with G-d. He also notes Rav Acha's prayer and quotes the Mishnah Berurah, OC 230:4 s.k. 6, who states, "One shouldn't think that they will receive a healing other than from G-d. Therefore, through saying this prayer, he will place his trust in G-d and request healing from Him." While this seems to be an extreme formulation that [nearly] removes the human component of healing and places it back into the hands of G-d, I think it is identical to the blessing of Rafeinu to be discussed shortly.

(6) While I can't speak to what the Sages who composed this blessing felt about the role of doctors, I do think we can use this background to help gain perspective on one way of understanding this blessing in our times.

(7) http://opensiddur.org/siddurim/ashkenaz/the-authorised-daily-prayer-book-aka-the-singer-siddur/




References: Berachot: 18a Kiddushin: 82a Tzitz Eliezer: 5  

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