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Attending: Medicine, Mindfulness, and Humanity
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 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 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.
As a third-year Harvard Medical School student doing a clinical rotation in surgery, Ronald Epstein watched an error 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 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.
304 pages, Hardcover
Published January 24, 2017
279 people are currently reading
2985 people want to read
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Displaying 1 - 30 of 136 reviews
January 31, 2020
Thoughts soon.
March 18, 2017
Attending isn't necessarily a book for everyone, but I appreciated many of the ideas Dr. Epstein puts forth. I think the primary audience is anyone in a health care provider, student, or administration role. However, as a massage therapist and patient I still found the ideas relevant and eye-opening.
First, I'll say that Attending rotates between being interesting and being a bit dull. It's certainly well researched, with about 35% of the book as footnotes and references.
Dr. Epstein clearly describes the components of being a mindful physician, as well as having a mindful medical practice. Those components are qualities that anyone in the health care field can incorporate into their interactions with both patients and colleagues.
This was the point in the book where I wished I knew doctors who practiced this way. And then I considered buying copies of the book for all of the physicians I see regularly. And reading it out loud to them!
After describing the ideals of Attending, Dr. Epstein explains the reality physicians face every day. With electronic health records and productivity quotas, the structure of health care today doesn't automatically encourage a mindful approach. But that's why mindful, compassionate, and curious practices matter more than ever. Epstein makes a strong case for this approach as a method to help prevent and / or fix physician burnout.
After reading about the realities of a doctor's life, I expect to be a more compassionate and understanding patient as well. Plus, I think the Attending approach should be taught at all medical schools and conferences. It sounds like it can save the lives of patients and physicians!
Thanks to NetGalley, Scribner, and the author for a digital review copy in exchange for this honest review.
First, I'll say that Attending rotates between being interesting and being a bit dull. It's certainly well researched, with about 35% of the book as footnotes and references.
Dr. Epstein clearly describes the components of being a mindful physician, as well as having a mindful medical practice. Those components are qualities that anyone in the health care field can incorporate into their interactions with both patients and colleagues.
This was the point in the book where I wished I knew doctors who practiced this way. And then I considered buying copies of the book for all of the physicians I see regularly. And reading it out loud to them!
After describing the ideals of Attending, Dr. Epstein explains the reality physicians face every day. With electronic health records and productivity quotas, the structure of health care today doesn't automatically encourage a mindful approach. But that's why mindful, compassionate, and curious practices matter more than ever. Epstein makes a strong case for this approach as a method to help prevent and / or fix physician burnout.
After reading about the realities of a doctor's life, I expect to be a more compassionate and understanding patient as well. Plus, I think the Attending approach should be taught at all medical schools and conferences. It sounds like it can save the lives of patients and physicians!
Thanks to NetGalley, Scribner, and the author for a digital review copy in exchange for this honest review.
March 24, 2017
Okay, as far as a literary work, it is probably a 3.5 on this scale, but I rated it a 5 because of the importance of the message in this book and Dr. Epstein's ability to get this point across.
As I was reading this book, my mother became ill and was diagnosed with stage 4 colon cancer and had a very quick decline and death. I was able to see firsthand all of the problems that Dr. Epstein describes, and through the hospice care physicians, I was able to see the positive aspects he reported.
As a physician myself, I see great value in this book, and I believe that the tools described here are essential to TRUE health care reform, and I am inspired to act and help bring about this change in any way I can.
As I was reading this book, my mother became ill and was diagnosed with stage 4 colon cancer and had a very quick decline and death. I was able to see firsthand all of the problems that Dr. Epstein describes, and through the hospice care physicians, I was able to see the positive aspects he reported.
As a physician myself, I see great value in this book, and I believe that the tools described here are essential to TRUE health care reform, and I am inspired to act and help bring about this change in any way I can.
June 21, 2017
Blergh...I really wanted to like this, but when the author started talking about his time at a zen center, I realized this wasn't going to be sciencey enough for me. Way to hippy dippy. I didn't finish it, and I think that was a great call. 0/10
May 1, 2024
5.1.24 RIP
This entire review has been hidden because of spoilers.
August 22, 2025
Ronald Epstein is a longtime family medicine physician at the University of Rochester who has frequently written about mindfulness in medicine. In his 2017 book Attending, he draws heavily on his decades practicing medicine as an attending physician (for non-healthcare folks: an attending physician is someone who is licensed to practice independently after completing medical school, residency, and fellowship training), his memorable patient experiences, and and his mentoring and teaching of trainees. The core of Attending is reflecting on the challenges of practicing medicine in an increasingly technological and isolating age.
As an attending physician myself, I resonated with much of this. The reminders to slow down, listen closely, and remain empathetic are always important. Epstein is humble and open about his own mistakes, and his emphasis on humility as a core strength of good practitioners struck a chord. Those who assume they’re beyond error often stop learning, whereas those who acknowledge fallibility tend to be better doctors. In medical training we're scrutinized under a microscope and picked apart for any reason (valid or not), but once we cross the threshold of being attendings, those guardrails are largely gone.
At times, Attending leaned too far into the “woo-woo” side of mindfulness for my taste. I should admit some of my reaction is colored by personal history: I began residency the year this book was published, and my program reacted to a tragic event involving a resident in a different specialty by instituting mandatory “wellness” sessions for all residency programs. These required meetings, held at painfully early hours after overnight calls, forced us into sharing vulnerabilities in ways that felt artificial and inappropriate, with the penalty for not attending being doing even more call shifts, hence amplifying the destructive cycle of sleep deprivation that led to unwellness and precipitated errors in the first place.
Still, this was a worthwhile read, alongside other books I'll link below. Though published before the COVID era, it anticipates many of the conversations we’ve since had more openly about burnout, self-care, and the humanity of healthcare providers as well as patients.
Further reading:
When We Do Harm: A Doctor Confronts Medical Error by Danielle Ofri, MD
Being Mortal: Medicine and What Matters in the End by Atul Gawande, MD
The Beauty in Breaking by Michele Harper, MD
My statistics:
Book 261 for 2025
Book 2187 cumulatively
As an attending physician myself, I resonated with much of this. The reminders to slow down, listen closely, and remain empathetic are always important. Epstein is humble and open about his own mistakes, and his emphasis on humility as a core strength of good practitioners struck a chord. Those who assume they’re beyond error often stop learning, whereas those who acknowledge fallibility tend to be better doctors. In medical training we're scrutinized under a microscope and picked apart for any reason (valid or not), but once we cross the threshold of being attendings, those guardrails are largely gone.
At times, Attending leaned too far into the “woo-woo” side of mindfulness for my taste. I should admit some of my reaction is colored by personal history: I began residency the year this book was published, and my program reacted to a tragic event involving a resident in a different specialty by instituting mandatory “wellness” sessions for all residency programs. These required meetings, held at painfully early hours after overnight calls, forced us into sharing vulnerabilities in ways that felt artificial and inappropriate, with the penalty for not attending being doing even more call shifts, hence amplifying the destructive cycle of sleep deprivation that led to unwellness and precipitated errors in the first place.
Still, this was a worthwhile read, alongside other books I'll link below. Though published before the COVID era, it anticipates many of the conversations we’ve since had more openly about burnout, self-care, and the humanity of healthcare providers as well as patients.
Further reading:
When We Do Harm: A Doctor Confronts Medical Error by Danielle Ofri, MD
Being Mortal: Medicine and What Matters in the End by Atul Gawande, MD
The Beauty in Breaking by Michele Harper, MD
My statistics:
Book 261 for 2025
Book 2187 cumulatively
January 31, 2020
Lots of great info concerning mindfulness and prescience in the healthcare field. Highly recommended for anyone in Medicine.
February 26, 2023
Goed boek, maakt goede punten.
Ik zou het zeker wel aanraden voor iedereen die in de gezondheidszorg werkt.
Het boek zelf zegt dat het voor iedereen is, maar ik zie dit de meeste mensen niet interesseren.
Sorry kben effe te lui om een decent review te schrijven.
Ik zou het zeker wel aanraden voor iedereen die in de gezondheidszorg werkt.
Het boek zelf zegt dat het voor iedereen is, maar ik zie dit de meeste mensen niet interesseren.
Sorry kben effe te lui om een decent review te schrijven.
February 27, 2024
Quite possibly the worst book I’ve ever read. Would have put it down after page 10 if I was not required to read it for school. The author writes with an extremely arrogant and preachy voice. I usually can find some meaning from mindfulness in medicine books, but all this did was make me more mindful of the pain and suffering endured while reading this book.
I have a lot more to say, but I’ll keep this short to avoid running the risk of rambling and spewing worthless words, as this author spent 200 pages doing.
I have a lot more to say, but I’ll keep this short to avoid running the risk of rambling and spewing worthless words, as this author spent 200 pages doing.
July 25, 2017
Really good read on mindfulness training and preventing burnout. While written about medicine, this would seem very applicable for those in the police force (where officers must make quick judgements in high stress situations) and teaching. Highly recommend this read!
July 14, 2022
read for class. pretty easy to read and the points resonated.
February 2, 2023
Good book. Insightful. At the same time these kinds of books frustrate me because they shine a light on the potential we have to fix medicine and have doctors and nurses that aren’t burned out. Yet working in the system each day I can’t see the medical profession standing up for themselves and fight for their ability to care for patients or for themselves any time soon.
September 17, 2017
Mindfulness has become so common in public discourse, that it suffers from overuse. Epstein has been publishing articles about mindfulness and medicine for many years and has nicely brought many threads together in this book.
It is hard to discern the intended audience at times. The public will find it of interest to consider the advantages of physicians who incorporate mindfulness in their medical practice. Physicians will reflect on the importance of its message to both their patients and themselves.
The term work-life balance is common in medical (and other) circles currently and Epstein points outthe problems with this trope. conceiving of everything outside work as life and that one needs to balance these activities, implies that when you are at work, you're not fully alive. If you are unhappy at work, then, you place the source at things external to yourself...your work environment. Feeling unable to change the larger system leads to retreating more and more into non-work or life. In medicine, this ignores the deeper rewards, the life, of the work involved. This division between 'work' and 'life' lies at the source of much burn out in the profession.
The book is written in a conversational way (what Pinker, in his book The Sense of Style: the thinking person's guide to writing in the 21st century, calls the classical style), which makes it easy to read. The drawback to this is that many of the sources referred to in the book are found in endnotes. My preference would be footnotes.
It is hard to discern the intended audience at times. The public will find it of interest to consider the advantages of physicians who incorporate mindfulness in their medical practice. Physicians will reflect on the importance of its message to both their patients and themselves.
The term work-life balance is common in medical (and other) circles currently and Epstein points outthe problems with this trope. conceiving of everything outside work as life and that one needs to balance these activities, implies that when you are at work, you're not fully alive. If you are unhappy at work, then, you place the source at things external to yourself...your work environment. Feeling unable to change the larger system leads to retreating more and more into non-work or life. In medicine, this ignores the deeper rewards, the life, of the work involved. This division between 'work' and 'life' lies at the source of much burn out in the profession.
The book is written in a conversational way (what Pinker, in his book The Sense of Style: the thinking person's guide to writing in the 21st century, calls the classical style), which makes it easy to read. The drawback to this is that many of the sources referred to in the book are found in endnotes. My preference would be footnotes.
May 12, 2018
This book tackles important questions within medicine that have often been left by the wayside. At times, the author's voice may seem a little distracted and repetitive, but this comes his persistent attempt to convince others of the real impact that mindfulness, a somewhat intangible concept (especially to a reader with little experience), has on the day-to-day life of not just medicine and healthcare, but many service industries.
January 15, 2025
This was a great read (listen). Dr. Epstein clearly has well-developed, strong views, and passion about the need for mindfulness in medicine. You would be hard-pressed to find a clinician that would disagree with most of his claims for a need for more compassionate, empathetic medicine. The most interesting point to me as a first year med student, is the need for physicians that more fully PROCESS the emotions of themselves and their patients instead of the trained "echo", "name", and "reflect" the feelings we see.
I hope to integrate some of his principles in my life in and out of medicine. I also loved that reading about how a passion/interest developed as a medical student ended up shaping his career in a meaningful way.
Some of the principles were a bit repetitive, I found it easier to read the last 1/3 of the book because there were some interesting, different takes supported by more real and raw stories.
I hope to integrate some of his principles in my life in and out of medicine. I also loved that reading about how a passion/interest developed as a medical student ended up shaping his career in a meaningful way.
Some of the principles were a bit repetitive, I found it easier to read the last 1/3 of the book because there were some interesting, different takes supported by more real and raw stories.
May 12, 2017
A must read for doctors, care professionals and health and social care institutions. And anybody else Thanks to Net Galley and to Scribner for providing me with an ARC copy of this book that I freely chose to review.
If they asked me to provide a single word review of this book, I would write AMEN.
Ronald Epstein, the author and practising doctor with his own clinic, after years of studying a variety of disciplines (including music, meditation, Philosophy, Zen, Medicine…) and of trying to find the best way to maintain a practice sensitive to the needs of patients, compassionate, focused on well-being and avoiding suffering, rather than on billing, money and the business-side of things, published an article called ‘Mindful Practice’ in 1999. The article was very well received and resulted in the author becoming a speaker and offering training to other health professionals, emphasising the important of being mindful of one’s practice. In this book, the author shares his insight and knowledge to help other physicians avoid errors, burnout, and remember what Medicine should really be about. He offers plenty of background research and information (with abundant notes that take up more than a third of the book and a useful bibliography for those who want to check the original sources) interspersed with case stories that illustrate the topics. These include cases Dr Epstein had personal experience of (both as a physician and as a patient) and others that he’s accumulated over years of educating other professionals and talking to friends and colleagues. These cases not only reinforce the theoretical points but also add a practical and personal touch that can be lost in purely theoretical texts.
The book is written in a fluid and clear style, accessible and interesting also to those who might not work in healthcare, although it is particularly geared towards health professionals. Due to the themes and subjects touched upon, this book would be useful to individuals and institutions heavily invested in helping people and dealing with the public, in particular, those offering care. Although many of the reflections are particularly pertinent to individuals, the emphasis on education and the fact that many of the qualities discussed, like compassion and resilience can be taught, are particularly important for organisations and institutions that manage human resources. As Dr Epstein explains, they would go a long way to help avoid professional burnout.
Although Attending mentions Zen, neurocognitive studies, philosophers’ books, mindfulness and meditation, the overall message does not require an in-depth knowledge of any of those subjects and I cannot imagine anybody who would not find something useful in this volume.
As a doctor and one who left the job a few years back less than enamoured with the way health care is organised, I kept nodding all the way through. I highlighted so many sentences and quotes that I cannot share them all, but I will choose a few ones that I felt were particularly pertinent:
Medicine is in crisis. Physicians and patients are disillusioned, frustrated by the fragmentation of the health care system. Patients cannot help but notice that I spend more and more time looking at computer screens and less time face-to-face. They experience the consequences of the commodification of medicine that has forced clinicians’ focus from the healing of patients to the mechanics of health care —productivity pressures, insurance regulations, actuarial tasks, and demoralizing metrics that measure what can be counted and not what really counts, sometimes ironically in the name of evidence-based and patient-centered care.
Maslach found that burnout consisted of three factors: emotional exhaustion, depersonalisation (treating people as objects), and a feeling of low personal accomplishment.
But now, in the age of the corporatization and widgetization of medicine, there is a new kind of burnout, a slow, relentless “deterioration of values, dignity, spirit and will” that comes from the structure of health care itself.
The problem is not only overwork; it’s a crisis of meaning, resilience, and community.
As I said, I think this book should be required reading for medical students, qualified doctors and also for other professionals working in healthcare and those who manage staff and organise the educational programmes of institutions, not only those providing healthcare but also any that deal with the public and its problems on a regular basis.
If I were to make a suggestion, it would be that the book could easily be made even more relevant to other disciplines by adding examples pertaining to other professions (not only nurses or paramedics but also social workers, counsellors, teachers…). It is clear from the content that although the principles can be applied individually, organisations would also do well adopting the ideals and attitudes highlighted by the research. Becoming attentive, compassionate, curious and mindful would help patients and staff increase their wellbeing and avoid burnout and complaints.
I recommend this book to all healthcare professionals, and those interested in how to improve healthcare and increase the resilience and wellbeing of staff. I think that anybody could potentially benefit from this book, and I’d recommend checking the sample if you think it might help you. I will definitely recommend it to some of my previous work colleagues.
If they asked me to provide a single word review of this book, I would write AMEN.
Ronald Epstein, the author and practising doctor with his own clinic, after years of studying a variety of disciplines (including music, meditation, Philosophy, Zen, Medicine…) and of trying to find the best way to maintain a practice sensitive to the needs of patients, compassionate, focused on well-being and avoiding suffering, rather than on billing, money and the business-side of things, published an article called ‘Mindful Practice’ in 1999. The article was very well received and resulted in the author becoming a speaker and offering training to other health professionals, emphasising the important of being mindful of one’s practice. In this book, the author shares his insight and knowledge to help other physicians avoid errors, burnout, and remember what Medicine should really be about. He offers plenty of background research and information (with abundant notes that take up more than a third of the book and a useful bibliography for those who want to check the original sources) interspersed with case stories that illustrate the topics. These include cases Dr Epstein had personal experience of (both as a physician and as a patient) and others that he’s accumulated over years of educating other professionals and talking to friends and colleagues. These cases not only reinforce the theoretical points but also add a practical and personal touch that can be lost in purely theoretical texts.
The book is written in a fluid and clear style, accessible and interesting also to those who might not work in healthcare, although it is particularly geared towards health professionals. Due to the themes and subjects touched upon, this book would be useful to individuals and institutions heavily invested in helping people and dealing with the public, in particular, those offering care. Although many of the reflections are particularly pertinent to individuals, the emphasis on education and the fact that many of the qualities discussed, like compassion and resilience can be taught, are particularly important for organisations and institutions that manage human resources. As Dr Epstein explains, they would go a long way to help avoid professional burnout.
Although Attending mentions Zen, neurocognitive studies, philosophers’ books, mindfulness and meditation, the overall message does not require an in-depth knowledge of any of those subjects and I cannot imagine anybody who would not find something useful in this volume.
As a doctor and one who left the job a few years back less than enamoured with the way health care is organised, I kept nodding all the way through. I highlighted so many sentences and quotes that I cannot share them all, but I will choose a few ones that I felt were particularly pertinent:
Medicine is in crisis. Physicians and patients are disillusioned, frustrated by the fragmentation of the health care system. Patients cannot help but notice that I spend more and more time looking at computer screens and less time face-to-face. They experience the consequences of the commodification of medicine that has forced clinicians’ focus from the healing of patients to the mechanics of health care —productivity pressures, insurance regulations, actuarial tasks, and demoralizing metrics that measure what can be counted and not what really counts, sometimes ironically in the name of evidence-based and patient-centered care.
Maslach found that burnout consisted of three factors: emotional exhaustion, depersonalisation (treating people as objects), and a feeling of low personal accomplishment.
But now, in the age of the corporatization and widgetization of medicine, there is a new kind of burnout, a slow, relentless “deterioration of values, dignity, spirit and will” that comes from the structure of health care itself.
The problem is not only overwork; it’s a crisis of meaning, resilience, and community.
As I said, I think this book should be required reading for medical students, qualified doctors and also for other professionals working in healthcare and those who manage staff and organise the educational programmes of institutions, not only those providing healthcare but also any that deal with the public and its problems on a regular basis.
If I were to make a suggestion, it would be that the book could easily be made even more relevant to other disciplines by adding examples pertaining to other professions (not only nurses or paramedics but also social workers, counsellors, teachers…). It is clear from the content that although the principles can be applied individually, organisations would also do well adopting the ideals and attitudes highlighted by the research. Becoming attentive, compassionate, curious and mindful would help patients and staff increase their wellbeing and avoid burnout and complaints.
I recommend this book to all healthcare professionals, and those interested in how to improve healthcare and increase the resilience and wellbeing of staff. I think that anybody could potentially benefit from this book, and I’d recommend checking the sample if you think it might help you. I will definitely recommend it to some of my previous work colleagues.
January 27, 2019
I was drawn to this book because I'd finally found a physician who is conscious about connecting with her patients, and spends enough quality time to get to the root of a problem. I came across this book and was intrigued to find out the reality for most doctors. This is a thought-provoking, fact-filled look at the current state of the medical profession. It carefully lays out the issues that doctors face, along with effective ways to move toward a more fulfilling practice, both for the physicians and their patients.
December 31, 2020
Onmisbaar boek voor elke gezondheidswerker. Epstein confronteert ons met onze aandacht en vooral ook ons frequente gebrek daaraan en reikt tools aan om meer 'aanwezig' te zijn, al klinkt dat misschien een beetje wollig. Soms is het boek een beetje langdradig of zelfs saai, maar zo gaat dat in psychologische boeken denk ik! Ik neem er alleszins een hele hoop lessen uit mee voor mijn dagelijks leven en praktijk.
July 30, 2023
3/5. I didn’t gain as much as I hoped from this book but maybe that’s because I know more than I realized on the topic. I thought the book simplified many concepts and was an intro to many techniques. Some of the examples felt too superficial.
September 16, 2024
message of book 5 stars actual reading experience 3 stars. was a bit too introductory level understanding of mindfulness for my taste. would be a good required reading for med school or something as a reminder but not very profound
July 30, 2024
I think I will get more from this book if I reread it at different stages of my career.
December 31, 2024
Important message but the book was so boring and repetitive and hard to get through and probably could have been a longer article rather than a full book.
March 21, 2025
Really great chapter on helplessness in health care!
July 27, 2024
Extremely considerate expose on being a doctor in the most mindful and humane way possible; first half of the book was very helpful, the author rightly acknowledges and discusses many of the medical philosophers who actually grasp the nature and function of the medical enterprise (a.o. Kathryn Montgomery and in the footnotes; Michael Polanyi); the latter half of the book is a bit too heavy on the mindfulness/meditation angle to my taste, otherwise this would have been a favorite.
April 24, 2017
Dr. Ronald Epstein’s recently published book Attending: Medicine, Mindfulness, and Humanity is 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.
“Attending” is both a term for the senior physician on a care team as well as a state of attentiveness. Both definitions are important here – the book draws from theories of mindfulness, which Epstein brought to the attention of medical practitioners in a 1999 JAMA article. This book explains the difference between being attentive and being present and how both are involved in the makings of an excellent physician. Epstein also explores more abstract concepts like curiosity and intuition, explaining with engaging examples how these characteristics are invaluable to the best clinicians.
The book reads like an eloquent explanation of the modern challenges to good doctoring. He addresses a variety of issues, from the breakdowns in communication between physician and patient to the challenges of providing empathic care in systems that are built for financial optimization rather than for healing. He also addresses important contemporary topics such as burnout and medical errors, devoting careful thought to these hotly debated problems.
Epstein does not just explain the relevant issues; he also writes about ways these problems can be curtailed or avoided. He uses anecdotes from his own experience in medical school and training as well as experiences and lessons he has learned about from colleagues, friends, and patients. He draws also from his extensive reading, including quotes and concepts from various scholars, including the philosopher Michel Foucault and the poet Jalal ad-Din Rumi. The result is an enjoyable amalgamation of human experience, applied to the complicated challenges faced by humanistic clinicians in today’s era of healthcare.
Epstein highlights the importance of a sound mind throughout the book. He explains many aspects of mindfulness practice, citing specific characteristics that can be improved using mindfulness techniques. He also provides an opportunity for clinicians and other healthcare providers to sharpen these skills by teaching specific exercises in the book.
Written by an engaging communicator, Attending is an enjoyable foray into the mind of someone who has carefully considered the challenges to today’s practice of medicine. Epstein provides thoughtful replies to a variety of concepts using compelling narrative and engaging anecdotes. This book is an important read for anyone who wants to critically engage with the humanistic practice of medicine.
-Ali Rae, APGF Health Communications Fellow
“Attending” is both a term for the senior physician on a care team as well as a state of attentiveness. Both definitions are important here – the book draws from theories of mindfulness, which Epstein brought to the attention of medical practitioners in a 1999 JAMA article. This book explains the difference between being attentive and being present and how both are involved in the makings of an excellent physician. Epstein also explores more abstract concepts like curiosity and intuition, explaining with engaging examples how these characteristics are invaluable to the best clinicians.
The book reads like an eloquent explanation of the modern challenges to good doctoring. He addresses a variety of issues, from the breakdowns in communication between physician and patient to the challenges of providing empathic care in systems that are built for financial optimization rather than for healing. He also addresses important contemporary topics such as burnout and medical errors, devoting careful thought to these hotly debated problems.
Epstein does not just explain the relevant issues; he also writes about ways these problems can be curtailed or avoided. He uses anecdotes from his own experience in medical school and training as well as experiences and lessons he has learned about from colleagues, friends, and patients. He draws also from his extensive reading, including quotes and concepts from various scholars, including the philosopher Michel Foucault and the poet Jalal ad-Din Rumi. The result is an enjoyable amalgamation of human experience, applied to the complicated challenges faced by humanistic clinicians in today’s era of healthcare.
Epstein highlights the importance of a sound mind throughout the book. He explains many aspects of mindfulness practice, citing specific characteristics that can be improved using mindfulness techniques. He also provides an opportunity for clinicians and other healthcare providers to sharpen these skills by teaching specific exercises in the book.
Written by an engaging communicator, Attending is an enjoyable foray into the mind of someone who has carefully considered the challenges to today’s practice of medicine. Epstein provides thoughtful replies to a variety of concepts using compelling narrative and engaging anecdotes. This book is an important read for anyone who wants to critically engage with the humanistic practice of medicine.
-Ali Rae, APGF Health Communications Fellow
July 23, 2018
I really enjoyed this book even though it's targeted for doctors and clinicians. The book moves along and isn't too medical lingo centric which is nice for the laymen. The mindfulness concepts can be applied by everyone in whatever field or domain you find yourself. If you're into meditation and breathworks, much of this should be familiar to you.
You will learn about Dr. Epstein's experience as a medical professional and as a patient and the examples in the book are all very relatable. Brain science is included of course and you'll get to neuroplasticity on page 177, if that's your thing.
Being mindful is an experience. One must be present, curious, engaged, and attentive. The author takes you chapter by chapter through these concepts. Burnout is discussed in chapter 10. How to become mindful is discussed in chapter 11. There is a short ending chapter on mindful healthcare organizations. To learn more about how to actually practice mindfulness, I would suggest checking out videos online. If you live in California, you have an advantage as this stuff is everywhere! Further reading is required on this topic or actually taking a mindfulness class or two to learn how to meditate if you've never done so!
You will learn about Dr. Epstein's experience as a medical professional and as a patient and the examples in the book are all very relatable. Brain science is included of course and you'll get to neuroplasticity on page 177, if that's your thing.
Being mindful is an experience. One must be present, curious, engaged, and attentive. The author takes you chapter by chapter through these concepts. Burnout is discussed in chapter 10. How to become mindful is discussed in chapter 11. There is a short ending chapter on mindful healthcare organizations. To learn more about how to actually practice mindfulness, I would suggest checking out videos online. If you live in California, you have an advantage as this stuff is everywhere! Further reading is required on this topic or actually taking a mindfulness class or two to learn how to meditate if you've never done so!
March 13, 2017
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!
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!
May 14, 2023
Ronald Epstein, MD sets the stage for his book, which attempts to take many of the insights of Buddhist mindfulness meditation and apply them to the practice of medicine, by defining attending physician, from which he derives the title of his book.
“In medicine, the senior physician responsible for patient care is called the attending physician or the attending. The attending’s responsibility is to direct the clinical team’s attention to the most important things, take charge, make the patient feel attended to, and provide attentive care. Attending means showing up, being present, listening, and accompanying patients when it matters most. Attending is also a moral imperative: by being attentive, doctors not only provide the best care, they also honor each patient’s humanity.”
As all medical trainees know, the attending supervises a team that typically consists of medical students and post-graduate (from medical school) trainees, such as interns and residents. Epstein makes clear why he thinks attendings must bring the benefits of mindfulness to the team when he later discusses both medical school and residency.
“Med school was an environment of extremes. Altogether, I saw too much harshness, mindlessness, and inhumanity. Medical school was dominated by facts, pathways, and mechanisms; residency was about learning to diagnose, treat, and do procedures, framed by pit-of-the-stomach dread that you might kill someone by missing something or not knowing enough. Given the life-and-death stakes, I found it jarring that, with few exceptions, medical training did not emphasize deep listening - to oneself or to others. While extolling the virtues of reflection and compassion, medical training largely ignores the development of those capacities…I felt disappointed and alone and didn’t see a path forward.”
The book largely describes applications of mindfulness meditation as Dr. Epstein’s solution and way forward. Dr. Epstein introduces George Engel’s ‘biopsychosocial model’. Asserting that doctoring involves a relationship between two people, he emphasizes the importance of human emotions. To be effective, doctors must be aware of, and capable of controlling their own emotions. They must also be sensitive to the emotions of their patients if they are going to help their patients with their plights, which are introduced by the illnesses and diseases which doctors purport to treat. This syllogism forms the basis for the book's central thesis: the practice of mindfulness meditation can improve both the quality of care and the quality of caring, delivered by doctors, at the same time that it addresses the resilience of those doctors.
Having introduced the team leader, or attending, as one who requires executive attention to function optimally, the author develops the theme of focused attention. He cites the famous quote of William Osler. “We miss more by not seeing than by not knowing”, to emphasize the potential benefits of mindfulness meditation in medical education, training, and practice. This chapter includes brief accounts of a number of neurobiological data and psychological studies. This leads directly to a discussion of curiosity, not only as a necessary component of learning but also as an antidote to fear of uncertainty. He emphasizes the embrace of uncertainty for doctors and patients. It is his assertion, as it is of meditation authority, Jon Kabat-Zinn, that mindfulness meditation can help lessen our fear of uncertainty, and ultimately facilitate our acceptance of not knowing everything.
I found Dr. Epstein’s introduction of the ‘beginner’s mind’ concept in Buddhism resonant with historian and futurist, Yuval Noah Harari’s conceptualization that until we acknowledge that there are things we do not know, it is very difficult for us to learn, or be taught. Analogous to embracing uncertainty through mindfulness, meditation can help us see ourselves as open to new knowledge.
Epstein introduces the idea of ‘being present’, whether we are alone, with a family member, or with a patient. The discussion of ‘being present’ is built upon the Buddhist principle of ‘non-doing’. As opposed to seeing oneself as always having the answer, or solving every problem, we begin to learn to listen without immediately speaking and rendering opinion or judgment. We are introduced to empathy and compassion from clinical perspectives.
The central importance of uncertainty is further developed by the author’s notion that our teachers and supervisors in medical training had to undertake their journeys without a map and so will we. The author introduces the reader to the idea of problem-solving, the distinction between simple, complicated, and complex problems. “In medicine knowledge of diseases, guidelines, and clinical evidence carry you just so far. When you are choosing a doctor, you want one who has something Aristotle called 'phronesis', loosely translated as practical wisdom. Phronesis is about choosing which actions will serve this patient best, right now.” Some of this difference hinges on the uniqueness of each individual patient, as opposed to the statistical mean of a patient summarized by the best clinical trials and registries. That uniqueness is not limited to biology, it also includes patient values and patient’s socioeconomic status, and the place the patient is in his lifecycle.
This discussion leads to a clear statement of some of the limitations of algorithmic or guideline-directed medical care. “Proponents of decision algorithms were puzzled when the algorithms were infrequently adopted They learned that clinicians and patients just didn’t think that way, nor did they want to. The idea that every patient would have the same ‘utilities’ was particularly presumptuous… The (statistical) models tended to assume that humans are rational decision-makers, a proposition that is both attractive and ludicrous – attractive because it improves the likelihood that decisions reflect our underlying values, and ludicrous because so many nonrational factors influence the decisions we make.”
The author defines compassion as:
• Noticing another person’s suffering
• Resonating with, or feeling, another’s suffering, and
• Acting on behalf of that other person.
He then uses the concepts of empathy and compassion, as specifically developed by loving-kindness meditation in dealing with adverse outcomes and medical mistakes. He goes on to develop these ideas in helping care providers deal with their own problems such as anxiety, depression, burnout, substance abuse, and doctor suicide. These kinds of applications of mindfulness meditation are the heart of the book for me and among the many reasons I recommend reading it.
The final attempts to envision a compassionate healthcare system are less well-developed and less useful to me. Alternatively, I find the suggestions for becoming a more mindful patient compelling not only because doctors will eventually become patients. I also think it emphasizes the human relational aspect of caregiving, and it reinforces the notion that compassion for others begins with self-compassion.
“In medicine, the senior physician responsible for patient care is called the attending physician or the attending. The attending’s responsibility is to direct the clinical team’s attention to the most important things, take charge, make the patient feel attended to, and provide attentive care. Attending means showing up, being present, listening, and accompanying patients when it matters most. Attending is also a moral imperative: by being attentive, doctors not only provide the best care, they also honor each patient’s humanity.”
As all medical trainees know, the attending supervises a team that typically consists of medical students and post-graduate (from medical school) trainees, such as interns and residents. Epstein makes clear why he thinks attendings must bring the benefits of mindfulness to the team when he later discusses both medical school and residency.
“Med school was an environment of extremes. Altogether, I saw too much harshness, mindlessness, and inhumanity. Medical school was dominated by facts, pathways, and mechanisms; residency was about learning to diagnose, treat, and do procedures, framed by pit-of-the-stomach dread that you might kill someone by missing something or not knowing enough. Given the life-and-death stakes, I found it jarring that, with few exceptions, medical training did not emphasize deep listening - to oneself or to others. While extolling the virtues of reflection and compassion, medical training largely ignores the development of those capacities…I felt disappointed and alone and didn’t see a path forward.”
The book largely describes applications of mindfulness meditation as Dr. Epstein’s solution and way forward. Dr. Epstein introduces George Engel’s ‘biopsychosocial model’. Asserting that doctoring involves a relationship between two people, he emphasizes the importance of human emotions. To be effective, doctors must be aware of, and capable of controlling their own emotions. They must also be sensitive to the emotions of their patients if they are going to help their patients with their plights, which are introduced by the illnesses and diseases which doctors purport to treat. This syllogism forms the basis for the book's central thesis: the practice of mindfulness meditation can improve both the quality of care and the quality of caring, delivered by doctors, at the same time that it addresses the resilience of those doctors.
Having introduced the team leader, or attending, as one who requires executive attention to function optimally, the author develops the theme of focused attention. He cites the famous quote of William Osler. “We miss more by not seeing than by not knowing”, to emphasize the potential benefits of mindfulness meditation in medical education, training, and practice. This chapter includes brief accounts of a number of neurobiological data and psychological studies. This leads directly to a discussion of curiosity, not only as a necessary component of learning but also as an antidote to fear of uncertainty. He emphasizes the embrace of uncertainty for doctors and patients. It is his assertion, as it is of meditation authority, Jon Kabat-Zinn, that mindfulness meditation can help lessen our fear of uncertainty, and ultimately facilitate our acceptance of not knowing everything.
I found Dr. Epstein’s introduction of the ‘beginner’s mind’ concept in Buddhism resonant with historian and futurist, Yuval Noah Harari’s conceptualization that until we acknowledge that there are things we do not know, it is very difficult for us to learn, or be taught. Analogous to embracing uncertainty through mindfulness, meditation can help us see ourselves as open to new knowledge.
Epstein introduces the idea of ‘being present’, whether we are alone, with a family member, or with a patient. The discussion of ‘being present’ is built upon the Buddhist principle of ‘non-doing’. As opposed to seeing oneself as always having the answer, or solving every problem, we begin to learn to listen without immediately speaking and rendering opinion or judgment. We are introduced to empathy and compassion from clinical perspectives.
The central importance of uncertainty is further developed by the author’s notion that our teachers and supervisors in medical training had to undertake their journeys without a map and so will we. The author introduces the reader to the idea of problem-solving, the distinction between simple, complicated, and complex problems. “In medicine knowledge of diseases, guidelines, and clinical evidence carry you just so far. When you are choosing a doctor, you want one who has something Aristotle called 'phronesis', loosely translated as practical wisdom. Phronesis is about choosing which actions will serve this patient best, right now.” Some of this difference hinges on the uniqueness of each individual patient, as opposed to the statistical mean of a patient summarized by the best clinical trials and registries. That uniqueness is not limited to biology, it also includes patient values and patient’s socioeconomic status, and the place the patient is in his lifecycle.
This discussion leads to a clear statement of some of the limitations of algorithmic or guideline-directed medical care. “Proponents of decision algorithms were puzzled when the algorithms were infrequently adopted They learned that clinicians and patients just didn’t think that way, nor did they want to. The idea that every patient would have the same ‘utilities’ was particularly presumptuous… The (statistical) models tended to assume that humans are rational decision-makers, a proposition that is both attractive and ludicrous – attractive because it improves the likelihood that decisions reflect our underlying values, and ludicrous because so many nonrational factors influence the decisions we make.”
The author defines compassion as:
• Noticing another person’s suffering
• Resonating with, or feeling, another’s suffering, and
• Acting on behalf of that other person.
He then uses the concepts of empathy and compassion, as specifically developed by loving-kindness meditation in dealing with adverse outcomes and medical mistakes. He goes on to develop these ideas in helping care providers deal with their own problems such as anxiety, depression, burnout, substance abuse, and doctor suicide. These kinds of applications of mindfulness meditation are the heart of the book for me and among the many reasons I recommend reading it.
The final attempts to envision a compassionate healthcare system are less well-developed and less useful to me. Alternatively, I find the suggestions for becoming a more mindful patient compelling not only because doctors will eventually become patients. I also think it emphasizes the human relational aspect of caregiving, and it reinforces the notion that compassion for others begins with self-compassion.
July 3, 2017
Scribner and NetGalley provided me with an electronic copy of Attending: Medicine, Mindfulness, and Humanity. I was under no obligation to review this book and my opinion is freely given.
Attending is a book about mindfulness and medicine, changing the way that physicians think in order to provide more compassion to their patients. As health care has been more about the groundbreaking technologies than humanity, Dr. Epstein offers a way to improve the quality of care.
As a professor of Family Medicine, Psychiatry, and Oncology at the University of Rochester School of Medicine and Dentistry, Dr. Epstein directs mindful practice programs. He emphasizes the importance of attending - showing up, being present, and listening to patients. Self awareness on the part of the doctor is the key. Being able to listen to a diverse set of clues, in order to help the patient, is another. Curiosity is a skill that allows doctors an avenue through which they can engage with their patients. Applying Zen principles is an alternative, not only for physicians, but for patients as well, because achieving the emptiness of mind can provide the focus for the issue at hand.
Overall, Attending is a book that can provide useful information to medical professionals, patients, and their loved ones. Dr. Epstein gets to the heart of the matter clearly and concisely, with an honesty that is refreshing. I would recommend this book to both physicians and their patients, as I feel that all can learn valuable lessons from Dr. Ronald Epstein.
Attending is a book about mindfulness and medicine, changing the way that physicians think in order to provide more compassion to their patients. As health care has been more about the groundbreaking technologies than humanity, Dr. Epstein offers a way to improve the quality of care.
As a professor of Family Medicine, Psychiatry, and Oncology at the University of Rochester School of Medicine and Dentistry, Dr. Epstein directs mindful practice programs. He emphasizes the importance of attending - showing up, being present, and listening to patients. Self awareness on the part of the doctor is the key. Being able to listen to a diverse set of clues, in order to help the patient, is another. Curiosity is a skill that allows doctors an avenue through which they can engage with their patients. Applying Zen principles is an alternative, not only for physicians, but for patients as well, because achieving the emptiness of mind can provide the focus for the issue at hand.
Overall, Attending is a book that can provide useful information to medical professionals, patients, and their loved ones. Dr. Epstein gets to the heart of the matter clearly and concisely, with an honesty that is refreshing. I would recommend this book to both physicians and their patients, as I feel that all can learn valuable lessons from Dr. Ronald Epstein.
March 6, 2021
I was really excited to read this book as a physician and someone who is interested in the topic. I did find the material interesting and relevant, but I think stretching it out into a full book made it a bit repetitive. But I found his writing very “preachy” and self-congratulatory, very humble-bragging.
Eg: while he was away a man with a sore shoulder saw three of his colleagues who attributed it to a chronic shoulder injury but when HE got back he noticed a lump and diagnosed a lymphoma. “Only physicians exquisitely attuned to salient clues can see what is really there”.
Another time he diagnosed angina and sent a woman to the ER just by listening to her, even though she came in with minor complaints.
As a Med student was the only one who noticed an ischemic kidney in the OR but surgeon didn’t listen to him.
E.g At first he dismissed abdo bloating in a middle aged woman with multiple somatic complaints but then noticed her weight loss, brought her back in and diagnosed her ovarian cancer in time for a cure!
And other examples...
Still, some food for thought about attention, listening with an open mind, and compassion, the more “human” side of medicine.
Eg: while he was away a man with a sore shoulder saw three of his colleagues who attributed it to a chronic shoulder injury but when HE got back he noticed a lump and diagnosed a lymphoma. “Only physicians exquisitely attuned to salient clues can see what is really there”.
Another time he diagnosed angina and sent a woman to the ER just by listening to her, even though she came in with minor complaints.
As a Med student was the only one who noticed an ischemic kidney in the OR but surgeon didn’t listen to him.
E.g At first he dismissed abdo bloating in a middle aged woman with multiple somatic complaints but then noticed her weight loss, brought her back in and diagnosed her ovarian cancer in time for a cure!
And other examples...
Still, some food for thought about attention, listening with an open mind, and compassion, the more “human” side of medicine.
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