Read Excerpts from Dr. Shuch’s Book:

Doctor, Be Well: Integrating the Spirit of Healing with Scientific Medicine.

Chapter 23

Attention

I am your patient. By taking that role I am intentionally going to let my guard down and let you see me, touch me, and even assault me in a very specific and hopefully therapeutic way. I am going to let my guard down and be passive to allow you to see and to do what needs to be seen and done. It takes a conscious act of effort for me to suppress my usual defense mechanisms and be open, vulnerable and perhaps naked.

You will be assuming a certain power and control over me. When I open myself up to you in this way, how safe will you make me feel? Will you ignore my humanity and treat me only as a broken part to be fixed, or will you honor my presence as you work?

If you lose sight of me in the face of your “repairing me”, and I become just a broken part to you–how did that occur in you? If your education was so focused on me as a mechanism to be repaired, then you have been taught implicitly that you can ignore that which is not my mechanism. If your education gave you so much knowledge about my mechanism and only about my mechanism, then how you treat me in your process may be of little consequence to you.

To me as your patient, in a passive vulnerable state, this comes across in a very palpable way as arrogance. It feels to me like you feel that you know so much about my mechanism–more than I will ever know about whatever part you are specializing in repairing for me, that you don’t need to bother with “me”. That part of the “deal” as you see it is for me to understand that you fixing my part is such a technical tour-de-force that you couldn’t possibly have the time or attention to also focus on “me” at the same time. And further, that to do so would be superfluous. In your paradigm you would say–“What’s the point. It’s not necessary. It’s not my job.”

Well perhaps when you were a student doctor, first learning your skills, that was true. But what is your excuse now? When your habitual energy can do the entire repair work, where is the rest of your attention?

It is said that when an artist or musician has become a master, that their technical virtuosity represents only 20% of their work. That 80% of their attention resides on interpreting and communicating on the level of their feelings. Where is my focus when I am attending to you? If I have mastered the technical skills that I need to treat you so that it is to me like driving my car on a road that I have driven on one thousand times before, then where is the remaining 80% of my attention? Am I focused on twenty five other things: the patient in the next room, the five more I will need to see before the day is out, the argument I had with my spouse, the pain in my back? Am I lost in a tempo of rushing, in worry about the past or anxiety about the future? Or have I confined my attention to you in the present moment?

How clear is my focus? Am I looking to pigeonhole you into a diagnostic category a.s.a.p. or can I bring a quality of attention that allows me to hear more than just what your words say? Can I, like the waiter in a fine restaurant, be of service to you?

What quality of attention can I bring to my patient? Can I be empty enough of the busyness in my mind to listen in a conscious way? Can I be clean enough of my emotional baggage and my ego that as I listen, I can begin to put myself into my patient’s experience and try to perceive with empathy how it is for them? Can I be grounded enough in my body so that if my patient is feeling the drama of her condition, I can listen, yet not be consumed by pity or sympathy?

As much as our patient’s covet our time, even more so do they covet our attention. It is up to us what the quality of that attention is and it is up to us what the quality of our attention can be. As important as it is for us to listen with consciousness, this process is more than simply being open to whatever comes in. It would be that easy if our patients always knew the truth to tell us–we could just listen and accept everything that we heard, saw and sensed without the need for discernment. It is not that our patients are trying to fool us; rather, they may not know the truth themselves. They may have rationalized the choices that they have made, some of which may include ignoring signs that their body was not well. Now they may still be “in denial” and for us, we must listen and observe. It is not that we are looking to catch them in a lie and call them on it like some trial lawyer in a court of law. For us it is more a matter of seeing what is, so that we may begin to question ourselves, “What will be possible for this person? How might they be open to seeing what it is that they need to see in order to find the desire and the will to live in a healthier way?”

Joyce was a patient of mine for a short period of time. She could never arrive on time for her appointments and always was in some kind of a crisis, both emotionally as well as with her dental condition. She told me of her failing marriage, devastating illnesses in her family, money problems, and of course her dental emergencies. At first I was consumed in her drama and would drop everything to help this poor woman. Then it dawned on me that I was feeding her addiction for sympathy and that the only way that I could be of any real help to her was to have empathy for her, yet constrain her to follow the flow of time that we established for her in our office. It was a learning experience for me to see that she did not wish to get better, she only wished to live in her drama and find enough sympathetic ears amongst her friends and doctors so that she could perpetuate her life as she saw it.

As I engaged her in conversation about these issues, she would justify her behavior at every turn on the one hand, and demonstrate that she felt victimized by the conversation on the other hand. I have seen this dichotomy in people many times in my professional life, vacillating between self-justification and victimhood, often with an unrecognized anger or arrogance at its core. In individuals caught in this groove, there is no opening to reach them. This trap is not only one that catches patients, but one that equally catches doctors. I have encountered doctors who protect their core beliefs about “science” and “medicine” from within this same dichotomy. Once Joyce saw that we would only help her to get better, she left our practice. I recall that before I realized what was happening, that I would be exhausted at the end of any of her visits.

Attention of the kind that I am referring to here is a product of conscious energy. As such it is a part of the superluminal world where this kind of energy in a very real sense, animates us. Just as a superluminal field can exist inside of an electromagnetic field, or not, we can function with conscious energy and attention, or not.

But can I simply will myself to have more attention in a particular moment? And what quality of attention am I capable of? In the common understanding of attention the issue of quality isn’t often considered. Rather I know that I can focus my attention on something or someone in most circumstances. Of course if I am very tired, my mind may not be able to “go there”. Likewise if I am in some kind of emotional upheaval or in physical pain, I may be unable to will myself to pay attention. But this understanding of attention implies that it is all the same stuff; it is of one quality and it is either there or it is not. Within our working model, this would be habitual attention, the black or white issue of it being “on” or “off”.

But conscious attention is something else. It is not something that I can will into the moment in a direct way. Rather it is a quality that I need to prepare myself to receive. What can I do in order to allow this force, this superluminal energy, to reside within the bioelectromagnetic field that can be its home within me?

Like tuning in a radio station amidst the static, we are receivers of energy. The question then becomes in what way can I “tune my circuits” to receive this energy? First I must have the experience in my bones that this kind of energy isn’t with me very much. For if I believe that it is with me every waking moment of every day, I will see no point in trying to gain that which I feel that I already possess. But if I can see that this is something that I only have at unpredictable times, then this question becomes something very real for me.

Conscious energy is like a laser, and these days laser light is used to carry information efficiently along fiber optic cables. We can be the receivers of that laser-like energy, except that we are like one thousand little mirrors that disperse and reflect it away, such that it loses its strength and focus. What can I do to synchronize my parts so that the coherent light of superluminal energy can make a strong unitary impression in me rather than have me be just one thousand weak reflections? How can I synchronize myself?

It comes down to a matter of sensitivity. If I can quiet my mind. If I can experience my emotional state without being consumed by it. If I can relax my body and have a sense of it–movement, posture, muscle tone, then I have reduced the static that would ordinarily keep me from hearing and experiencing this quality of energy. Then perhaps I can be present in the moment with my patient in a way that has a different quality than that which is my usual habit.