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The Power of 'Enough-ness' in Medicine

— How the principles of "Dayenu" apply in everyday practice

Last Updated June 27, 2024
MedpageToday
A photo of a woman waiting to be seen in an examination room.
Lazarus is an adjunct professor of psychiatry.

My son, his wife, and their 3-year-old son recently made the long flight from their home in Honolulu to our "summer" home in Asheville, North Carolina, a lovely town situated in the foothills of the Blue Ridge Mountains. Normally, my wife and I make the trek to Honolulu twice a year to visit them. However, this time, we were spared a visit (expense), and in doing so, we were able to have a large family and friends gathering.

After their visit, as I dropped off my son at the airport, I looked at him intently and said, "You know, your mother and I would have met you half-way. It would have been enough for you to fly to the west coast and meet us there rather than schlep to Asheville."

My son immediately invoked the Hebrew term "Dayenu" (pronounced "die-yay-new"). "Dayenu" translates to "it would have been enough." "Dayenu" is both an expression and a song. The latter consists of 15 stanzas referencing different historical contexts the Israelites experienced during slavery in Egypt. It is traditionally sung on Passover to express gratitude for each of the many gifts that God bestowed to the Jewish people during their exodus from Egypt, stating that each act in itself would have been enough.

While "Dayenu" originates from a religious context, its underlying principles can offer valuable secular lessons, even in healthcare. Applying the concept of "Dayenu" to the practice of medicine may seem unconventional, but it can manifest in various ways. One instance is in patient care, where physicians can encourage patients to adopt an attitude of gratitude for any progress they make in their health journey, regardless of the size. This can contribute to patient satisfaction and overall mental well-being, which can also positively affect their physical health.

The concept of "Dayenu" can help physicians appreciate their achievements and the progress they've made in their career or in treating a patient, even if they haven't reached the end goal. Healthcare providers can find solace in each small improvement in a patient's condition. Celebrating small victories can boost the morale of physicians, helping to mitigate burnout, which is arguably the most plaguing problem in the medical profession today.

As "Dayenu" (the song) builds, it calls out miracles, punctuating each one with Dayenu! The song's structure, which highlights a series of incremental steps, parallels the step-by-step approach often needed in medical treatment and recovery. Understanding that each small improvement is significant can help manage expectations and maintain motivation in long-term care or complex medical situations.

"Dayenu" teaches the importance of seeing the broader picture while recognizing the value of individual components. In medicine, this can translate to a holistic approach to patient care, where addressing physical, emotional, and psychological aspects of health are all deemed important.

The principles of sufficiency and contentment inherent in "Dayenu" can prompt healthcare providers to reflect on ethical issues such as the limits of intervention, resource allocation, and the balance between aggressive treatment and quality of life. Specifically, the principle of "Dayenu" aligns with the idea of avoiding overtreatment in medical interventions. This approach recognizes when enough has been done for a patient's health, understanding that further intervention may not improve, and could potentially harm, the patient's quality of life.

The historical context of "Dayenu" is one of overcoming adversity and oppression. In medicine, maintaining resilience and hope is crucial for both patients facing difficult diagnoses and for healthcare workers managing the demands of their profession. The song's message can be a source of inspiration and strength.

In essence, the values represented by "Dayenu" -- gratitude, contentment, and moderation -- originating from a specific religious tradition can be universally applied, including within the field of medicine. By drawing lessons from this ancient song, healthcare professionals can enhance their practice, ensuring they not only treat illnesses but also nurture the overall well-being of their patients.

is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine, including and .