Attending: Medicine, Mindfulness, and Humanity

Book Title: Attending: Medicine, Mindfulness, and Humanity

Book Author: Ronald Epstein

Publication Information: New York, Scribner, 2017, 287 pp, $26, hardcover

As burnout rates soar in medicine, mindfulness is the new buzzword. In this book, Ronald Epstein, MD translates the concept of mindfulness for health care providers; he takes it far beyond practice to more of a way of being. If you were under the misconception that mindfulness equals meditation, Epstein’s book will set you straight. In medicine, it is about compassion, addressing errors, having curiosity, and ultimately being comfortable in one’s own skin. In the first sentence, he reminds us that “human understanding starts with understanding oneself.” His goal is to help us with self-preservation and much more; he describes attending as “showing up, being present, listening, and accompanying patients when it matters most.” Attending, he argues is a moral imperative that allows for the best care and a way to honor patients’ humanity.

What makes this book so accessible is the style of Dr Epstein’s writing. He layers one set of wisdom upon another. He has practiced in Rochester, New York for years, and shares plenty of stories. While he uses powerful idioms like the importance of knowing the patient versus simply knowing about the patient, he solidifies each important concept with an anecdote that solidifies his message.

The book oscillates between theories and very useful analogies. He includes concepts such as decision theory, explores rationale versus narrative, and the “whole mind” versus the “shared mind.” Believe me, this material is fascinating because of how practically it is presented, and readers will have many “Ah-ha” moments realizing why they and patients behave the way they do. The book is well researched with 25 pages of 400+ references. Research aside, the book focuses on everyday issues like getting frustrated with patients or angry about being inefficient. Epstein shows us how practicing mindfulness allows us to gain a metacognitive approach to these situations and transform how we react in real time. Some lessons are as basic as noticing the flowers in the patient’s room to show them you are present, and as complex as being self-aware enough to take a time-out in a heated situation to become calm by simply focusing on your feet planted on the ground.

I admit to having become a disciple of Epstein’s approach. It inspired me to take some mindfulness courses and I am now living what he preaches. That is how inspiring the book can be! Epstein implies that merely reading the book will not get you to an enlightened state. It is a challenging journey but one worth pursuing. He chides that mindfulness is usually the domain of poets and philosophers but is ultimately at the core of health care and medicine. He argues that being a doctor is about sharing information, being present, and being kind—and yet these traits are very difficult to achieve consistently and well within our fast-paced world and broken systems.

If the above is not reason enough to buy and read this book, let me highlight three other features. Epstein writes a treatise on suffering that, once read, will alter the way healers think about those who are in pain or are ill in a broader, more personal manner. He teaches us to move from empathy and rote statements (“sorry to hear that”) to compassion and engaging questions (“how are you dealing with that.”) He reminds us to transition from cure to care when appropriate and use the physical exam for touch and deep listening for validation. Second, his coverage of medical mistakes is different from others. Epstein delineates the physician as the “second victim” of patient errors and how projects around the country like the “Confession Project” are healing and transformative for participants. Finally, a step-by-step, two-page appendix provides a how-to-guide for medical mindfulness.

Academics will enjoy the discussion of learning theory and the differences between learners, experts, and masters. Students and residents will gain 20 years of acumen about practicing differently and may thus avoid some of the frustrations that many of us have endured. All readers will seek solace in Epstein’s rage against the system, chiding the pressures of health care and its demand for more productivity, when what we cherish is sincerity and caring. What is so satisfying about this book is the offered path to provider satisfaction, and not simply analysis. Epstein delves into the traits that lead to burnout and then outlines “stress inoculation” approaches including 10 resiliency factors. I think the book is so useful, I plan to give a copy to each of the learners I mentor.