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Attending: Medicine, Mindfulness, and Humanity

Attending: Medicine, Mindfulness, and Humanity

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by Ronald Epstein

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The first book for the general public about mindfulness and medical practice, a groundbreaking, intimate exploration of how doctors think and what matters most—safe, effective, patient-centered, compassionate care—from the foremost expert in the field.

As a third-year Harvard Medical School student doing a clinical rotation in surgery, Ronald Epstein


The first book for the general public about mindfulness and medical practice, a groundbreaking, intimate exploration of how doctors think and what matters most—safe, effective, patient-centered, compassionate care—from the foremost expert in the field.

As a third-year Harvard Medical School student doing a clinical rotation in surgery, Ronald Epstein watched an error unfold: an experienced surgeon failed to notice his patient’s kidney turning an ominous shade of blue. In that same rotation, Epstein was awestruck by another surgeon’s ability to avert an impending disaster, slowing down from autopilot to intentionality. The difference between these two doctors left a lasting impression on Epstein and set the stage for his life’s work—to identify the qualities and habits that distinguish masterful doctors from those who are merely competent. The secret, he learned, was mindfulness.

In Attending, his first book, Dr. Epstein builds on his world-renowned, innovative programs in mindful practice and uses gripping and deeply human clinical stories to give patients a language to describe what they value most in health care and to outline a road map for doctors and other health care professionals to refocus their approach to medicine. Drawing on his clinical experiences and current research, and exploring four foundations of mindfulness—Attention, Curiosity, Beginner’s Mind, and Presence—Dr. Epstein introduces a revolutionary concept: by looking inward, health care practitioners can grow their capacity to provide high-quality care and the resilience to be there when their patients need them.

The commodification of health care has shifted doctors’ focus away from the healing of patients to the bottom line. Clinician burnout is at an all-time high. Attending is the antidote. With compassion and intelligence, Epstein offers a crucial, timely book that shows us how we can restore humanity to medicine, guides us toward a better overall quality of care, and reminds us of what matters most.

Editorial Reviews

Publishers Weekly
Epstein, a family physician and professor at the University of Rochester School of Medicine and Dentistry, expands on his landmark 1999 essay in the Journal of the American Medical Association, which called for “mindful practice” on the part of physicians. Here he makes the case for using mindful practice to save both a medical profession “in crisis” and patients who are falling victim to “the fragmentation of the health care system.” Citing examples from his own practice, Epstein shows how taking time to pay attention to patients can lead to better outcomes on both sides of the stethoscope. He writes of one woman whose deteriorating health left him feeling helpless; after her recovery, she confessed that his uncertainty was reassuring: “ ‘At least,’ she said, ‘I knew you were being honest.’ ” Being mindful, Epstein states, is “a moral choice” for physicians. He also condemns the health care system and a culture of medicine that puts “clinicians in morally compromising situations” with electronic health record systems that are “sculpted around billing rather than good patient care,” and increased pressure on doctors “to see more patients without regard to quality.” Epstein’s treatise should be required reading for physicians, and it is also of vital interest to the patients in their care. (Feb.)
From the Publisher
“This book is phenomenal, and will be phenomenally useful to physicians and to all of us who are desperately in need of true health care and caring. It is hard for me to imagine a doctor reading it and not immediately recognizing, taking to heart, and implementing its messages in any number of different ways, being so commonsensical, clear, innately transformative, and healing. And it is equally hard for me to imagine that it will not energize all of us, when we find ourselves in the role of ‘the patient,’ to demand greater mindfulness from our care-givers across the board, and know what we mean by that.”—Jon Kabat-Zinn, author of Full Catastrophe Living and Mindfulness for Beginners

“As a student admissions committee member reviewing Ron Epstein's application to medical school, I knew he was special, a view surpassed by his visionary achievements illuminating the important nature of how physicians care for their patients, and how they can best care for themselves. Attending is the book every medical caregiver needs to strengthen their minds and harness their resilience to care for others—and every patient needs to understand how doctors think. This is a work of heart and head, a beautiful synthesis of inner wisdom and hard earned scientific empirical findings that point the way to proven methods for improving the lives of both giver and receiver of medical care. With clear explanations, captivating stories, and well-described challenges and approaches to their solutions, this book is exactly what the field of medicine needs.”—Daniel J. Siegel, M.D., author of Mind and The Mindful Brain and Executive Director, Mindsight Institute Founding Co-Director, UCLA Mindful Awareness Research Center

“I recommend Attending for anyone interested in health. In a most accessible way, Epstein makes a very convincing case for how doctors and patients would prosper from doctors becoming more mindful.”—Ellen Langer, PhD, Professor of Psychology, Harvard University, author of Mindfulness and Counterclockwise: Mindful Health and the Power of Possibility

"This powerful and inspiring book opens the pathway to bringing care, wisdom, and mindfulness into practice of medicine. A must-read for all clinicians and for lay readers as well."--Joan Halifax, PhD, author of Being With Dying

"Ronald Epstein cuts through the cacophony and illuminates the heart of the medical enterprise—the attentive and compassionate connection between doctor and patient. In a world awash with medical error, patient dissatisfaction, and burned-out doctors, this attention to mindfulness is much needed balm. Attending is at once penetrating, counterintuitive, and profoundly humbling."--Danielle Ofri, MD, PhD, author of What Patients Say, What Doctors Hear

"Attending got my attention from the opening paragraphs. Beautiful, compelling, and wise stories of how medicine and care-taking can be, (should be) when approached with common sense, a fierce sense of what is best for both the doctor and patient, and a compassionate heart. A timely and important book!"--Marc Lesser, CEO of Search Inside Yourself Leadership Institute (SIYLI) and author of Know Yourself, Forget Yourself and LESS: Accomplishing More By Doing Less

"Ronald Epstein truthfully and powerfully describes the challenging and changing worlds of both the physician and and the patient. Attending will encourage the recognition that mindfulness and compassion training contribute to effective medicine. The book clearly demonstrates how these contemplative practices can help enrich the lives of everyone involved in health care."--Sharon Salzberg, author of Lovingkindness and Real Happiness

"Epstein presents for general readers a concise guide to his view of what mindfulness is, its value, and how it is a skill that anyone can work to acquire."--Library Journal

"A deeply informed and compassionate book...[Dr. Epstein] tells us that it is a 'moral imperative' to do right by our patients. And he shows why and how."--Lloyd Sederer, New York Journal of Books

"Vivid... Epstein’s candor and courage...that makes the book so compelling."--Pharos

"Among the best books about how to teach the humanistic aspects of doctoring. Epstein weaves together an insightful collection of experiences that examine the clinician’s situation starting from inside her own mind and ending at the system in which she practices."--Gold Foundation

"Thoughtful company in times when we’ve never needed thoughtful company more."--Harvard Medicine

Library Journal
An anxious patient and a seemingly harried health-care professional sit in a small room talking, but little real communication occurs. Epstein (family medicine, psychiatry, & oncology; codirector, mindful practice programs, Univ. of Rochester Sch. of Medicine and Dentistry) says this scenario is all too common. Skilled professionals who avoid this use the practice, in some cases unknowingly, of mindfulness. Epstein's fascination with the topic and its application began in medical school and was affected by his time at the San Francisco Zen Center. He offers numerous anecdotes, both his own and those of others, and research looking at how becoming more mindful can improve communication and help to reduce errors, burnout, debilitating worry, and guilt. Heavily footnoted chapters include descriptions of exercises to enhance mindfulness and describe the difficulty of dealing with another's suffering and of showing compassion in ways that don't become overwhelming. Finally, he provides suggestions for physicians and other caregivers to become more mindful and for health-care systems to create structures that allow for that to happen. VERDICT While focusing primarily on health-care professionals, Epstein presents for general readers a concise guide to his view of what mindfulness is, its value, and how it is a skill that anyone can work to acquire. [See Prepub Alert, 8/1/16.]—Richard Maxwell, Porter Adventist Hosp. Lib., Denver
Kirkus Reviews
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.

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Meet the Author

Dr. Ronald Epstein is a practicing family physician, is a professor of family medicine, psychiatry, and oncology at the University of Rochester School of Medicine and Dentistry, where he directs the Center for Communication and Disparities Research and codirects Mindful Practice programs. He is an internationally recognized educator, writer, and researcher whose landmark article, “Mindful Practice,” published in the Journal of the American Medical Association in 1999, has revolutionized physicians’ view of their work. Dr. Epstein has been named one of America’s Best Doctors every year since 1998 by U.S. News & World Report. Visit Dr. Epstein at RonaldEpstein.com.

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Attending: Medicine, Mindfulness, and Humanity 5 out of 5 based on 0 ratings. 1 reviews.
literarymuseVC 16 days ago
What is medical practice like when a physician takes the time to tune into the patient, to find out what is going on in mind, body and spirit? Does a different diagnosis emerge from such sensitivity? Does the physician experience less stress in a system that is fraught with demands for quality performance at the least possible cost? Is this type of change necessary when physicians are so trained to churn out diagnoses from lists of diagnostic symptoms and formulas for treatment? Dr. Ronald Epstein attempts to answer these and other questions. His central thesis is that doctors who practice mindfulness as part of their practice are less stressed, more effective and more human, like their patients. Dr. Epstein describes his experience as a third-year Harvard Medical School student as he watched a surgeon operating on one kidney totally ignore that the other kidney was turning purple and looking engorged with blood. While that other kidney was within the surgeon’s field of vision, it had no primary concern or focus. The field was narrow but the surgeon’s focus was narrower. It may not seem like a big deal but it could have had fatal consequences. Perhaps you’ve heard a patient cite symptoms, feelings and questions in one long speech upon first entering a doctor’s office. How does the doctor handle that barrage and how many items can the physician handle? What can be ignored out of that list and should it be ignored? Dr. Epstein handles this answer without condemning doctor or patient and instead focusing on techniques of mindfulness that mean a doctor is more sensitive to everything coming into his medical surround. Mindfulness is enhanced with compassion and a state of constant curiosity on the part of the physician. Numerous medical anecdotes fill the pages as we learn about some of the components of mindfulness. The stories keep it all interesting as there is a bit much of repetition – perhaps a necessary mode as some may be tempted to pass over these elements of “how” to learn mindfulness and practice the same with patients. All in all, this is an interesting text for those who are teachers, students, practitioners, or administrators in medicine. Certainly, Dr. Epstein presents a model of medicine that will fascinate both practitioners and patients. Nicely done, Dr. Ronald Epstein!