The key to being an attending physician


When I graduated from residency, I was too worried about killing my first few patients to examine the meaning of being an attending physician. An early patient, a 97-year-old retired doc, brought it to my attention.

“Being an attending physician means you attend. When you attend me, all I want you to do is show up. You do not have to do anything. Keep the people with needles, knives, and nonsense away from me.”

We never discussed that I was his attending physician again. I was careful to do little for him besides our routine appointments. For him, the importance of “attend” was “show up” versus “do interventions.” This is attend in the spirit of “attend a basketball game” or “attend elementary school.”

When I became a patient, I learned other meanings of attend: Apply one’s mind or energies to, pay attention to. As in, I am attending the warning signs.

I had been bouncing around in the medical system for months. I was attending my symptoms quite assiduously. Some of my doctors seemed to be, and some did not. When my attending doctors did not seem to be applying their minds and energies, I felt like I was wasting my time and money, being told I was fine, despite not feeling fine, on the one hand, and having inappropriate tests on the other.

I get it. I’m a primary care doctor. My patients stream by so quickly that it is difficult to focus my gaze—never mind my attention—on each one before the system conveys me away to the next one and the next. Focussing my attention requires me to direct my energy, which is a surprising amount of work. However, if I do not direct my energy to each patient, I will miss details that aren’t really details.

The common expressions about attention—give, and pay—imply something of mine changing possession and going to the object of my attention. In exchange for the attention I pay to my patients, the present, shared moment is revealed to me. The opportunity to attend this moment is given by the act of attending to this moment. I am affected by being present in this moment. This being affected is what I am paying for with the attention that I am giving to the patient.

There are many ways to be present, but it seems to me that all of them require that I direct my attention to something. I find patients, by the nature of their being in the room with me and the palpability of their suffering, are easy aids to concentration of attention. I feel my practice of medicine is the most straight forward way available to me to practice presence at the moment.

Attend: Be present.

Attend: Pay attention.

The two meanings of attend converge here right now. If I can figure out how to be really present at my patient’s appointment, I will be applying my mind and energy to them. I cannot apply my mind and energy to them without really showing up. If I am present, I will be affected. My patients can tell. I can tell.

The first meaning of attend was taught to me as a doctor, by a retired physician who was my patient: only, be present. It is fitting that I learned more about attending as a patient from practicing physicians: pay attention.

The older I get, the more I see that attention is love made manifest. Let us show our love to and of our patients by being attending physicians, in every sense of the word.

Mary Braun is an internal medicine physician.

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