Are Patient Rounds Bikur Cholim?

Reeh 5779

“You shall follow Hashem your God and you shall fear Him…” (Devarim 13:5)

The Gemara (Sotah 14a) derives from the words “You shall follow Hashem” that a person should endeavor to emulate Hashem’s Midos. Therefore, just as Hashem clothes the naked, visits the sick, and comforts the bereaved, so should every person. The Gemara implies that these Mitzvos are d’Oraisa. However, the Rambam (Hilchos Avel 14:1) rules that they are Mitzvos d’Rabanan but one does fulfill the Mitzvah of “v’Ahavta l’Rei’acha Kamocha” when he performs them.

Why did the Rambam not cite the Pasuk above as the Biblical source for these Mitzvos, as implied by Chaza”l[1]? Rabbenu Avraham min haHar (Nedarim 39b) explains that the Rambam interprets this Gemara as using these Psukim as common examples of ideal interpersonal conduct, not providing a source for the obligation to perform these Mitzvos.

However, the Ramban (Hasagos on Sefer ha’Mitzvos 1 & 3) and Behag (Mitzvos Aseh 36) both maintain that these are Mitzvos min haTorah, as implied by the Gemara[2].

In any event, whether the Mitzva is d’Oraisa or d’Rabbanan, we generally think of the Mitzva of Bikur Cholim as a convivial visit (usually by a friend or relative), consisting of expressing interest in his condition and engaging and encouraging conversation. We do not usually consider a non-social visit by an unfamiliar person to be the Mitzva of Bikur Cholim. However, a review of some of the sources provides us with another perspective on the Mitzva.

The Tur (Y.D. 335) writes “When a person takes ill, it is a Mitzva for everyone to visit him…visiting the ill is a great Mitzva, as visiting will lead to:”

1. Davening for the patient
2. Inquiring about his condition and attending to his medical and personal needs
3. Cleaning and sanitizing his room and area
4. Taking away “1/60^th” of his illness

The Tur also mentions that one should not visit if it will cause embarrassment or stress (for example, if he is suffering from an embarrassing condition such as one requiring a urinary catheter or ostomy) or if it will cause him to become overly emotional or excited. In those cases, one should only go and inquire about his condition to see if there are any needs and to be inspired to Daven for him without actually entering his room.

The Beis Yosef (ad loc.) cites the Ramban (Toras ha’Adam p17) who also emphasizes that the purpose of the Mitzva of Bikur Cholim is to clean for the sick person and attend to his needs, to provide social engagement with his friend(s), and to inspire the visitor to Daven for him.

From these sources, it is apparent that an important aspect of the Mitzva of Bikur Cholim is attending to the various needs of a sick person. In fact, this is indicated by the word “Bikur” which can mean “an investigation” or appraisal of a situation[3]. A visitor is expected to appraise the general condition of the patient, clarify what his needs are and what will improve his situation, and, when appropriate, ensure that he is receiving the best medical care.

It follows that one should also be able to fulfill the Mitzva of Bikur Cholim over the telephone, as one may investigate a patient’s condition by calling and asking after him (Pachad Yitzchak, Igros u’Kesavim 33[4]). If the Mitzva is strictly to “visit” the sick, one would be unable to fulfill it over the phone[5].

This idea can also be proven from the comments of the Rosh (Hadar Zekeinim, Vayera). At the beginning of Parshas Vayera, the Torah relates that Hashem appeared to Avraham – “Vayera El Avraham” – and Rashi explains that Hashem had come to visit him as he was recovering from his Bris Mila. The Rosh notes that the Torah does not record that Hashem said anything to Avraham, and he explains that this teaches us Derech Eretz – a person should visit a sick person even if he will not converse with him at all (such as if he finds him asleep). When he awakens and is informed of his visitor, he will derive pleasure from the fact that somebody made the effort to come. If a person fulfills the Mitzva of Bikur Cholim when visiting somebody who is sleeping (because they will inform him of the visit afterwards), one would certainly fulfill the Mitzva by speaking with him directly on the telephone.

This perspective on the Mitzva of Bikur Cholim is applicable to the medical staff caring for patients. In addition to the Mitzvos of Gemilas Chasadim, “v’Rapo Yerapei”, Hatzalas Nefashos and Hashavas Aveida, one would also fulfill the Mitzva of Bikur Cholim.

The Sefer ha’Yashar[6] (Sha’ar 13, Sha’ar Avodas Hashem) rules that a doctor should visit people who are deathly ill no less than three times a day, and those who are in moderate condition in the morning and the evening. During his visits he should encourage them and wish them well.

A doctor’s visit needn’t only comprise a quick glance at the patient’s condition and treatment plan. He can strike up a conversation with the patient and probe whether he has family attending to him or not. Together with the rest of the medical staff, he can improve the patient’s mental state and give him warm words of encouragement.

When a patient senses that his doctor is interested not only in his medical condition but in his general emotional state and social situation, he will be buoyed and encouraged and this in turn may lead to a quicker or fuller recovery. A doctor who acts this way certainly fulfills the Mitzva of Bikur Cholim in the most ideal manner.

[1] The Rambam also doesn’t quote several other sources in Talmud Bavli (see Bava Metzia 30b and Nedarim 39b) that derive the Mitzva of Bikur Cholim from Pesukim in the Torah.

[2] In Sefer haMitzvos (Shoresh Alef), the Rambam explains why he argues with the Behag. Firstly, the source for the Mitzva of Chesed is not a Pasuk in the Torah, but is sourced in Nach or from the words of the Chachamim. Secondly, any matter that is derived by Chaza”l from expositions from Pesukim in the Torah does not have the status of a Mitzva d’Oraisa. Only those Mitzvos that are mentioned explicitly by the Torah are considered d’Oraisa. The Mitzvos mentioned by the Gemara in Sotah are Rabbinic in nature (although they are included in the Mitzva d’Oraisa of “v’Ahavta l’Rei’acha Kamocha”).

[3] As we find that Korbanos require “Bikur” to determine whether or not they have a disqualifying blemish or defect.

[4] He writes that “this matter is clear without any question”.

[5] See Igros Moshe (Y.D. 1:223) who writes that when one calls a sick person, while one does not achieve all that Chaza”l mention as being the purpose of Bikur Cholim, one does find out about a person’s condition and gives him the pleasure of talking to somebody. See also Minchas Yitzchak (2:84).

[6] Older versions of this Sefer attribute it to Rabenu Tam but others attribute it to Rebbi Zerachia ha’Yevani.