medical error prevention and, 191
San Francisco Department of Public Health, 155, 237n24
San Francisco Zen Center, 8, 51
Scardamalia, Marlene, 27
Scarpa, Patricia (patient), 32–33
schizophrenia, 72–73, 77
Schön, Donald, 65
Schroeder, David, 183
Schwartz, Ken, 198–99
Schwartz Center for Compassionate Healthcare, 127, 199
Schwartz Rounds program, 199
scripts, in clinical medicine, 31–32
Search Inside Yourself program, 84
secondary trauma, among physicians, 133, 143, 144–45, 154–55, 164, 174
Second Victim Rapid Response Team, University of Missouri Medical Center, 154–55
self-awareness
biopsychosocial approach to care and, 9
burnout and lack of, 166
compassion and, 129
confessions project for developing, 148
culture of health care organizations and, 197
curiosity and, 41, 49
importance of, 9
medical education on, 7, 174, 200, 213n19
mindful practice with, 10
oncologists and, 152
reactions of physicians to their mistakes and, 144
self-compassion, 153–54
self-determination, 228n2, 241n25
sensitivity to operations, in organizational mindfulness, 195
Shapiro, Jo, 155
shared mind, 78, 186, 229n15
decision making using, 93–94, 101, 105
leap from whole mind to, 187, 190
shared presence, 69, 72, 76, 77, 83–84, 186
Shayne, Michelle, 152
Shields, Cleve, 53
simplification, and organizational mindfulness, 194–95
Singer, Tania, 135, 235n28
Sinsky, Christine, 192
sitting meditation, 8, 82, 120, 184
smiling, and being present, 184
social epigenetics, 49, 165, 221n22
social presence, 77
soldiers, mind-fitness programs for, 174
Southwick, Steve, 164–65
Spivak, G. C., 188
Srivastava, Ranjana, 95
stillness practice, 81–83, 84
stress hormones, 82–83, 165, 174
Suchman, Tony, 11, 68, 197
suffering
definition of, 113
example of lack of specific diagnosis and continuing, 115–17
experiences in India viewing, 107–8
feeling of helplessness by physicians and, 117–19
inattention to, 112
lack of symptoms and, 111–12
learning to listen to, 123
mindful practice and, 11
pain associated with, 113
persistence of, after cure, 110–11
physicians’ acknowledgement of, 119–22
physicians’ attending to, 34, 84
physicians’ lack of awareness of, 113–15
physicians’ presence and sense of intimacy needed for, 72
physicians’ understanding of patients’, 52, 53, 56
refocusing and reclaiming at end of life and, 122–23
responding to, 107–23
secondary trauma among physicians from, 133
shared decision making and, 88
use of word by physicians, 107, 114
suicidal thoughts, and burnout, 162
suicides
of patient, psychiatrist’s reaction to, 145–46
of physicians, after medical errors, 146
surgeons
certainty and, 47
emotional content of patients’ conversations and, 19–20
example of lack of mindfulness in, 1–3
example of mindfulness in, 3–5
expertise and direct supervision of, 179, 180
focused attention and, 34
medical errors and suicide by, 146
peer coaching by, 155
presence and, 69
slowing down, 4–5
time spent on rounds by, 71
top-down attention and, 24–25
Suzuki, Shunryu, 51, 52, 57, 59
Tan, Chade-Meng, 84
taxi driver training research project on neuroplasticity, 177–78, 179
terror management theory, 48
testimony, treating patients’ experience as, 123
Three Days of Red (Maue), 30
Three Days of Red exercise, 30–31
time, presentness of, 70–71
To Err Is Human (Institute of Medicine), 194
top-down attention, 24–25
traditional Chinese medicine, 63, 232n8
trauma
resilience in reaction to, 165–66
secondary, among physicians, 133, 143, 144–45, 154–55, 164, 174
Trauma Informed Systems (TIS), San Francisco, 155, 237n24
tribalism, 79–80, 226n28
Tversky, Amos, 98
“Two Kinds of Intelligence” (Rumi), 61–62
University of Missouri Medical Center, 154–55
University of Rochester, 8, 9, 11, 125, 152, 214n22, 241n25, 247n16
video games, 76–77
Vipassana training (mindfulness meditation), 209–10, 215n28
virtual reality, in computer games, 76–77
Vogus, Timothy, 196–97
Volk, Karen, 115–17, 118
walking meditation, 64, 120
warning signs of burnout, 171–72
water jar test, 63–64
Waterman, Amy, 143
Web, guided meditations on, 210, 220n12, 248n2
Weick, Karl, 193, 194, 195–96, 197
well-being
leap to resilience from, 189
work-life balance and, 168–70
“where are my feet?” practice, 83–84
Willits, Jake (patient), 1–3
Wolk, Kathryn, 140–41, 142
Woollett, Katherine, 178
working memory, 18, 19
work-life balance
leap from well-being to resilience and, 189
well-being and, 168–69, 169–70
Zen dialogue about washing your bowl and, 169
Wu, Albert, 143
Zen Buddhism, 7–8, 129
Zen Mind, Beginner’s Mind (Suzuki), 51
Zen practice
approach to letting go of rigid assumptions in, 154
emptiness and, 59–60
meditation in, 182
sitting meditation in, 8, 82, 120, 184
slow-walking meditation in, 120
story about two perspectives told in, 56
wash your bowl dialogue in, 169
Zimmerman, Brenda, 89–90, 96
Zoppi, Kathy, 71–72
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Library of Congress Cataloging-in-Publication Data
Names: Epstein, Ronald, author.
Title: Attending : medicine, mindfulness, and humanity / Ronald Epstein.
Description: New York : Scribner, [2017] | Includes bibliographical
references and index.
Identifiers: LCCN 2016024695| ISBN 9781501121715 (hardcover : alk. paper) |
ISBN 9781501121722 (trade pbk. : alk. paper) | ISBN 9781501121739 (ebook)
Subjects: | MESH: Physician-Patient Relations | Mindfulness |
Physicians—psychology
Classification: LCC R690 | NLM W 62 | DDC 610.69/5—dc23 LC record available at https://lccn.loc.gov/2016024695
ISBN 978-1-5011-2171-5
ISBN 978-1-5011-2173-9 (ebook)
Two poems of Jellaludin Rumi translated by Coleman Barks used with the permission of Coleman Barks.
CT scan image appearing on page 18 reproduced with the author’s permission.