Ronald Epstein Scribner, 2017, HB, 304pp, £18.99, 978-1501121715
This is one of those very rare books that I would recommend as essential reading for every GP. It shows us how we can reinvigorate our clinical practice, and make Cum Scientia Caritas a living, breathing reality.
It’s all there in the title. In the US and Canada, an attending physician is someone who has completed their clinical training and practises their medicine in a clinic or a hospital. But an attending physician, of course, is also someone who pays attention, who takes note of the needs and desires of their patients, and equally of their own feelings and reactions.
Ron Epstein is a man of many talents. He is a professor of family medicine, psychiatry, and oncology, a practising physician, an experienced mindfulness practitioner, a highly respected researcher and educator, and an accomplished musician. I have had the pleasure of getting to know him during many NAPCRG conferences, including last year when we organised a workshop together on the self in primary care.
Structuring his book around the four foundations of mindfulness — Attention, Curiosity, Beginners’ Mind, and Presence — Ron deftly weaves rich stories from his own experience as doctor and patient together with contemporary research (much of it his own), Zen Buddhist philosophy and practice, music, and literature. And he writes like a dream. There are so many gems of wisdom to be found in this book. Here are some glimpses of what lies in store:
With help from the Persian poet Rumi, Ron shows us how Beginner’s Mind comes to life as ‘a freshness in the chest’, and being present means ‘be grateful for whatever comes/ because each has been sent/ as a guide from beyond’. A discussion of jazz improvisation reminds us of the practice of stillness, and the value of silence in the consultation.
There is a world of difference between knowing about my patient, and knowing my patient. It is all right to feel helpless from time to time; helplessness can be instructive. We may choose to turn towards suffering, not away from it. Becoming more aware of our own inner states enables us to look into our patients’ eyes, not just at their bodies, to notice their suffering, resonate with it, and act on their behalf.
In a wonderful chapter on the inner lives of physicians when things go wrong, Ron discusses how we become ‘second victims’, falling short and falling apart. Burnout is ‘an erosion of the soul’ and self-compassion is the antidote. He encourages us to ‘enjoy the unpredictable and chaotic corners of medicine’ and shows us that resilience can be grown.
Ron shares his ‘eight leaps’, including from detached concern to tenderness and steadiness, from whole mind to shared mind, and encourages us to find our own. He intersperses the text with practical meditation exercises, with my personal favourite — simply asking ‘Where are my feet?’ as a way to stay present, grounded in stressful situations.
And he reminds us, above all, to be gentle with ourselves.
- © British Journal of General Practice 2017
