ATTENDING

Can the encounter between doctor and patient be improved? A renowned family physician thinks so, and he explains how in this compendium of a lifetime of experience.

In chapters with titles like Being Mindful, Beginner’s Mind, Curiosity, Being Present, and Responding to Suffering, Epstein (Family Medicine, Psychiatry and Oncology/Univ. of Rochester School of Medicine and Dentistry) reminds us that “attending” is shorthand for the chief physician in charge of a specific case, but he also emphasizes how it describes a way of being present in the moment, sensitive to the thoughts and feelings of the patient. If that patient is suffering, the doctor must show compassion but also keep in mind the importance of avoiding burnout. Epstein contrasts this kind of attending with the hurried 15-minute encounter so common today, in which the doctor pronounces a diagnosis and a prescription while turning away to another case or the computer. Taking the time to truly engage can make all the difference in arriving at the correct diagnosis, gaining trust and compliance from the patient, and, over time, becoming a master in the field. In difficult terminal cases, for example, when the doctor hears the dreaded question, “what would you do if you were me?” it means pausing, not saying anything right away, and then asking more questions to arrive at what Epstein calls a “shared mind.” Much of the meaning of “attending,” as the author uses it, relates to the practice of meditation, and he offers some guidance on how to concentrate attention so the mind is not distracted or wandering. But Epstein is no spiritual preacher, and this is no New Age text. The author richly illustrates his arguments with case histories and stories of near mishaps in surgeries.

Worthy reading for medical students and practitioners but also applicable to other fields: artists, writers, musicians, teachers et al. can also fall into formulaic ruts and autopilot behavior and need literally to change their minds.