Can medicine really protect us from suffering, illness, or death? Join Dr. Jonathan Weinkle on this thought-provoking episode of Healing People, Not Patient as he explores the limits of medicine, the problem of uncertainty, and what healing professionals can learn from the ancient wisdom of Ecclesiastes about risk, relationships, and the fragile nature of life.
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What happens when we expect medicine to give us certainty in a world that can never guarantee it?
In this solo episode of Healing People, Not Patients, Dr. Jonathan Weinkle draws on Ecclesiastes, Jewish thought, literature, and clinical experience, to examine why medicine can create its own crises of faith when patients and clinicians mistake risk reduction for promises of good health.
The conversation explores the limits of prevention, the danger of turning medical recommendations into moral judgments, and how unexpected outcomes can cause patients to lose trust in medicine. From vaccines and chronic illness to treatment side effects and unanswered suffering, the episode challenges healthcare professionals to embrace humility while continuing to make meaningful differences in patients’ lives.
Ultimately, medicine is not about immortality. It is about gently nudging life toward better outcomes while recognizing uncertainty. The episode also highlights one of the most powerful tools available to healing professionals: human connection. Being present, building relationships, and helping patients reconnect with their communities may be just as important as the treatments we prescribe.
Top 3 Takeaways
Episode Mentioned
Episode 11: Dwelling in the 'Who Knows' - Chaplaincy in Crisis
About The Show
Healing People, Not Patients explores ways to enhance medical practice by infusing it with compassion, humanity, and a deeper sense of purpose, aiming to help healthcare professionals rediscover the "soul" of their work. Framed around the four questions of the Passover Seder, it probes how to transform medicine for the better, promoting an empathetic and supportive approach that empowers patients to create meaningful, sober lives, while drawing on Jewish teachings about community and friendship.
"Our theme song, 'Room for the Soul,' is available on Bandcamp at https://jonathanweinkle.bandcamp.com/track/room-for-the-soul."
About the Host:
Dr. Jonathan Weinkle is an internist and pediatrician who practices primary care at a community health center in Pittsburgh. He strives to be a "nice Jewish doctor" focused on patient-centered healthcare, emphasizing effective communication and holistic well-being.
He teaches the courses, “Death and the Healthcare Professions” and “Healing and Humanity” at the University of Pittsburgh, authored the books Healing People, Not Patients and Illness to Exodus, and runs ‘Healers Who Listen’, where he blogs on healing and Jewish tradition. Once an aspiring rabbi, he now integrates faith and medicine to support other physicians and his own patients.
🌐 Website: healerswholisten.com
🔗 LinkedIn: linkedin.com/in/jonathan-weinkle-3440032a
📸 Instagram: @HealersWhoListen
📘 Facebook: @JonathanWeinkle
[00:00:00] Do you believe in immortality? The sci-fi writer Robert Heinlein did. Starting with his nineteen forty-one novella, Methuselah's Children, he developed a story arc around the Howard families, a selectively inbred group whose first generation were made up of people with four grandparents who had made it to a hundred years old.
Within a couple hundred years, the oldest members were still going strong as they approached the close of their second century. The rest of society was jealous. The Howards were forced to keep their identities on the DL and identified one another in public with a sign countersign greeting that went like this: "The days are short, but the years are long.
Not while the evil days come not." If you recognize the last line, you're not alone. It's from the first verse of chapter twelve of the book of Ecclesiastes, called Kohelet in Hebrew, and it paints a picture of the reality that the rest of us, non-Howard family humans, face. Have a listen. Remember [00:01:00] now your Creator in the days of your youth, while the evil days come not, and the years draw near when you shall say, "I have no pleasure in them."
Before the sun, or the light, or the moon, or the stars are darkened, and the clouds return after the rain. In the day when the keepers of the house tremble, and the strong men bow themselves. The grinders cease because they are few. And those that look out of the windows are dimmed. And the doors are shut in the street, when the sound of the grinding is low, and one starts up at the voice of the bird, and all the daughters of music are brought low.
When they are also afraid of that which is high, and terrors are in the way, and almond tree blossoms, and the grasshopper drags itself along, and the caper berry fails. Because the man goes to his eternal home, and the mourners go about the streets. Before the silver cord is loosed, or the golden bowl is shattered, or the pitcher broken at the fountain , or the wheel broken at the cistern, and the dust returns to the earth as it was, and the spirit returns [00:02:00] to God who gave it.
" Utter futility," says Kohelet, "all is futile." It's The Jewish holiday of Sukkot this week, a time when Jews around the world commemorate wandering in the wilderness by sitting outside our sturdy homes in flimsy huts with leaky roofs, taking our meals and even sleeping close to the elements. It's supposed to be a joyous holiday, connected with the harvest and with surviving our season of repentance in one piece, but it's tinged with sadness.
Winter is approaching. There are people in the world, sometimes very near us, whose homes are always this rickety. And as Kohelet reminds us, our own personal permanent winters are always just around the corner. Come sit in my metaphorical sukkah with me for a brief episode about what healing professionals can learn from this gloomy, cranky, three thousand-year-old man.
Qohelet was another name for King Solomon, the wisest of all rulers and builder of the temple. For all his glory, Qohelet was a melancholy soul, and the book of his sayings is a long series of him [00:03:00] failing to find meaning or purpose in anything he had done . Part of his problem, he tells us, is that in the end, everyone ends up the same fate, even the animals.
What happens to humans happens to the beasts, the same fate. As one dies, the other dies. A human is no better than a beast. Everything is futile. That's chapter three, verse 19. That line comes in the middle of a longer lament, one which begins, "What advantage does the doer have from his labor? In particular, what benefit is there from being good?
What punishment from being evil? I saw wickedness in the place of judgment and wickedness in the place of righteousness." Qohelet's asking the question we refer to as theodicy. He's questioning the doctrine of whether reward for good behavior and punishment for bad behavior really exists in the universe.
He's not questioning the existence of God. In fact, he takes God's existence as a given, even in this same rant, saying, "Whatever God does, it shall be forever. Only God can find the [00:04:00] fleeting moment." God's real. God just doesn't work that way. It's a radical idea. It was radical for its time, radical to hear in the Jewish calendar in the same month where we observe Yom Kippur and are told in no uncertain terms how you behave definitely matters, a matter of life and death, in fact, and radical in the fact that it made it into the Bible in the first place.
There were rabbis that recommended not including it in the canon, even some who recommended banning, burying, or hiding it, or maybe if they had lived in this time, firing it out of a cannon. What's it doing here? And what can it teach those of us who aren't kings or rabbis or agricultural laborers in the late Bronze and early Iron Ages?
For example, I don't know, 21st century medical professionals and our patients About three years ago, I gave a lecture at UPMC Children's Hospital of Pittsburgh. It was called When Bad Things Happen to Good Patients. I was paraphrasing Rabbi Harold Kushner's famous book, written about his [00:05:00] crisis of faith when his son died of progeria.
But I was coming to a different point than Kushner. For him, his solace came when he concluded, like Kohelet, that God exists, and maybe unlike Kohelet, that God is all-knowing and all good, but probably not all-powerful. There are things for Kushner that are beyond even God's ability. Believing in a limited God is far more reassuring to him than an all-powerful God who chose not to cure his son.
For me, the issue is a different one. Medicine, like the religious doctrine of reward and punishment, seems to manufacture its own crises of faith, crises that threaten to undermine all the actual good we might be able to do if we saw ourselves as more limited than we think we are and framed our teaching in a more humble light.
Forget about God being limited. Let's think about our own limits. Doctors love to talk about risk factors, but don't love it when we realize that most of the people we're talking to don't understand what we mean by risk factor. [00:06:00] Explaining epidemiology is boring. It's why I start my episodes with stories, quotes, and jokes instead of facts or abstract concepts.
If I started mentioning odds ratios in the cold open, no one would stick around through the theme song. Having, consuming, or being exposed to a risk factor doesn't mean I'm going to get a disease. It just increases the odds of that happening, like putting on new running shoes instead of sneakers with a hole before going out to run that half-marathon that this podcast host will definitely not be entering.
For me, running is a heavy risk factor for embarrassing myself. Avoiding a risk factor doesn't mean I'm not getting the disease. It just improves my chances of steering clear, kind of like wearing a baseball glove improves but does not guarantee my chances of catching the ball being thrown to me at third base instead of it breaking my nose.
Now you know why I do a Jewish medical podcast and not a sports podcast . The problem with what [00:07:00] I just said is that it's not how we conduct ourselves, not in clinic, not in the hospital, and not in the public sphere. Convincing someone to do something that'll probably help or that might improve their overall health or that should prevent a disease feels like a lost cause, especially in the face of the disinformation that's always been there but feels louder and more brazen than ever before.
Might or should is unlikely to convince someone that they need to collect a sample of their own poop, give up their favorite food, or submit to an excruciating exercise regimen or any exercise regimen for that matter. So might becomes will, and adhering to, or in the old days, complying with a doctor's recommendation goes from being something agreeable to being a moral choice, the equivalent of being more righteous than someone who ignores recommendations or is, God forbid, non-compliant, which is essentially committing a medical sin.
And what happens then? [00:08:00] Around the same time Heinlein was writing Methuselah's Children, another novelist was looking to the past. His name was Milton Steinberg , a conservative rabbi who wrote a novel called As a Driven Leaf about a Talmudic rabbi who became a heretic. He cobbled together a number of stories from the Talmud about a rabbi named Elisha ben Abuyah, known as Acher.
We'll talk about that in a minute. Elisha hung with the greatest rabbis of his generation, including Rabbi Akiva, and Steinberg imagines him pulling them into his great philosophical project, writing a philosophical proof that God exists and the Torah is true. His faith is wavering, and he wants to replace faith with certainty.
Needless to say, he fails spectacularly. He continues to strictly observe the laws even as belief crumbles, until one day he and his companions are walking through an orchard. They see a boy and his father under a tree. The father instructs the boy to climb a ladder into the tree, shoo away the mother bird, and take the chicks from the nest.[00:09:00]
A simple scene, but a meaningful one. You see, both honoring one's parent and shooing away the mother bird before taking chicks from her nest are commanded in the Torah. What's more, both of these commandments are like medical advice because they come with an explicit promise of what will happen if you do them.
You will live a long life. Elisha and his companions watch in horror as the boy obeys his father, climbs the tree, shoos away the mother bird, takes the chicks, and then falls off the ladder on the way down and dies.
When one of the other rabbis approaches the dead child and pronounces the traditional Hebrew phrase, "Baruch dayan emet," blessed is the true judge, that's supposed to be recited on learning of a death, Elisha has had enough. At once, Elisha knew the answer to the question he had never ventured to face before, writes Steinberg.
A great negation crystallized in him. The veil of deception dissolved before his eyes. The only belief he still [00:10:00] cherished disintegrated as had all the others. The last tenuous cord that bound him to his people was severed, and when the sages droned on, their words buzzing like flies, revulsion swept Elisha.
He could no longer tolerate their deliberate blindness. In cold desperation, he silenced them. "It's all a lie," he said with terrible quiet in his voice. "There's no reward. There's no judge. There's no judgment, for there's no God." When the next section of the novel opens, he's been excommunicated, shaved his beard, sold his Jewish books, changed his manner of dress, and moved from the Galilee to Antioch, one of the great Roman cities of his time.
He has become Acher, other, and gone from being a rabbi to being a philosopher. It's not a stretch to say this happens with medicine all the time Philosophers and ethicists like to think in two-by-two tables, so let's imagine one. The most famous and relevant is Blaise Pascal's Wager. Imagine one [00:11:00] axis with God exists on one end and God doesn't exist on the other.
The other axis has an I am good on one end and I'm a sinner on the other. We get four boxes. In box one, God exists and I'm a good person, so I am rewarded eternally in heaven for my efforts. Yay, me. In box two, God exists, but I'm a sinner. I burn in hell. Ouch. In box three, I'm a good person, but God doesn't exist.
I'm Qohelet only without his enduring belief in God. I've toiled all my life, and what for? In box four, I'm a sinner, but there's no God. Pascal is cheerier than Qohelet, so he might say, "Well, at least you had fun, and you don't have to worry about punishment even if you're gonna die and all this will be forgotten."
Pascal chooses to take the bet on God existing and decides to behave himself. But what if Pascal just got lucky? Imagine his table, but instead of the [00:12:00] axis about God, replace it with an axis where one end says long life or good health, and the other early death or chronic sickness. If you're lucky enough to land in box one, everything's great.
You were a good person, and you got a long, healthy life as a reward. Even if Qohelet's right that the destination is the same for all of us, I think he'd be pleased about the journey. And if you land in box four, sickly or dead, and you were a sinner, well, serves you right, you jerk. The problem is boxes two and three.
People sin and live long, healthy lives, occupying box two with mansions and swimming pools. The Book of Psalms asked pointedly, "Until when? Until when will the wicked rejoice?" The world is full of Dorian Grays, except many of them are so lucky they don't even have ugly photos of themselves. It's not fair.
Box three is no better, littered with children dying of cancer and the wreckage of Rodó Clemente's rickety airplane. The righteous, or at least the innocent, cut [00:13:00] down too soon by a world that seems not to care. It's easy to lose faith, just like Acher did. And whether we mean to or not, we're setting up our own two-by-two in medicine.
The righteous behavior can be anything, like I said before, eating healthy, exercising, not smoking, taking our medicine. And yet for every person who abstains from alcohol to help themselves get healthier, a person makes the Guinness Book of World Records for longevity by drinking a Guinness every day.
And for every person who relies on their running fix to lose weight and feel great, there's a person like Jim Fixx, the 1980s running guru who died of a heart attack while running in 1984 at age 40 Our two by two table looks like this one, something I conceived of during the COVID pandemic. Box one, I masked, got my vaccine, social distanced, and I haven't had COVID once.
Box four, I'm sorely tempted to name names here, but I'm gonna resist the urge to schadenfreude. Just [00:14:00] say that this box is full of people who refused vaccination, didn't pay attention to the recommendations, and died of COVID. The reason I'm not gloating is because I can think of at least one person fitting that description for whom I was one of the last of two people to see them alive outside the hospital, the other being my practice partner Box two, don't own a mask, don't believe in the vaccine, may not even believe in the virus, and I've never gotten sick.
Box three, mask even when in my car by myself, haven't visited any of my relatives in years, still don't attend large gatherings more than five people, and somehow ended up with long COVID I think of the color-coded graphic showing a myriad of risky and less risky activities and wonder how the people in box two and box three must think of these things.
Let me be clear, especially in the pre-vaccine era, I was a huge proponent of distancing, masking, and caution all around. I am still strongly pro-vaccine. Really helps to prevent long COVID in particular, which is the biggest risk for most of us. I also see how completely the r- [00:15:00] rhetoric around the pandemic broke us as a society, and how many people ended up essentially like Acher.
Once they lost faith in those recommendations and that vaccine, the entire edifice, including all other vaccines, cancer care, even germ theory itself, came apart for them. Their belief in medicine toppled to the ground like that child falling off the ladder. Forget the true judge, they'll be their own judge or do their own research.
So what are we supposed to do? I think we need to start by admitting that medicine was never about certainty and never about immortality. The evil days come eventually for everyone. Qohelet's rant about everyone having the same fate in chapter three comes right after what may be the most famous lines in a book full of famous lines, the eight lines that Pete Seeger rhymed to himself, rhymed in English.
Qohelet's rant about everyone having the same fate in chapter three comes right after what may be the most famous lines in a book full of famous [00:16:00] lines. The eight lines that Pete Seeger rhymed in English and gave to The Byrds to record as the song "Turn, Turn, Turn." To everything there is a season, a time for every purpose under heaven, including for death.
But what we do with the time while the evil days come not, even if those years aren't as long as they are for Heinlein, is the business of medicine. Rabbi Jonathan Sacks taught that the word hevel, the word in Qohelet that people usually translate as vanity or, like I translate it, futility, actually means breath, specifically a shallow breath.
Shallowest of breaths, everything is a shallow breath. It's barely there, but it's there. And as long as it is, that is what we have to work with in the world. Shallow breath can be smothered by cancer, or it can live a hundred years. It can win a marathon or die trying. It is fragile. Heinlein would say ephemeral, his word for shorter-lived creatures [00:17:00] like, you know, us.
But as we learn from the story of Elijah, shallow breath may actually be what the voice of God sounds like. Sorry, Morgan Freeman. The business of medicine is to nudge things in the direction of letting that breath last longer, do more in the world than it might do otherwise. We have to be careful because it's unpredictable, and if we try too hard, we may blow it away I think of my friend Rabbi Jonathan Infeld, who estimates he lost more of his congregants to the side effects of COVID isolation than he did to the virus.
Take a listen to episode eleven, my interview with Rabbi Kara Tav, for the longer discussion of that story. I think of my patients earnestly trying to lose weight until they realize their GLP-1s are also robbing them of lean muscle. I think of patients who finally get their complex psychiatric illness under control and develop movement disorders from their meds.
And of course, I think of patients who diligently follow my advice on managing chronic pain, [00:18:00] nausea, or fatigue and see no improvement. We just nudge. We have one other job, which is to be present. "Two are better than one," says Qohelet. Three thousand years later, our studies of human flourishing teach us that strong, meaningful relationships, yes, even with your doctor, might be the single most valuable positive risk factor for long life and good health.
More than medicine, more than diet, more even than avoiding smoking. If one falls, their friend will stand them up. Healing professionals may not be with our patients for very long, but we can literally stand them up, providing with them the resources to literally get back on their feet, like the cane I prescribed today, or like my colleagues in PT do when they get someone walking again.
But also figuratively show even someone who's lonely that caring is possible, and help point them towards other connection and support outside our walls. Doctors in the UK take it so far as to do social prescribing. [00:19:00] I suspect the only reason we don't do it here is because no pharma company can figure out how to patent friendship.
Probably because Qohelet already knew about it millennia ago. And while one relationship is good, community is better. "A threefold cord," he says, "is not easily broken." I'm eighteen years into my career. A lot of my colleagues who have started when I did have burned out and left. Others remain but sound as cynical as Qohelet on his worst day.
I survive by reading this odd, subversive book in its entirety. Everything seems futile, out of our control, defying our attempts to believe in anything solid. But if we look at the little breath of hope and at the power of relationship, then we do have the power, the modest, gentle power to affect change and to achieve meaningful results together with the people we care for.
Even when it rains, even when the roof falls down, even when the evil days come after all.