Attending to patients and ourselves, with Melissa Lucarelli, M.D., FAAFP, and Ronald M. Epstein, M.D., FAAHPM

When patients talk about what they want from a visit with their physician, the answer is often simpler than the system makes it feel: they want to feel understood.

Melissa Lucarelli, M.D., FAAFP, a family physician, owner of Randolph Community Clinic and longtime editorial advisor for Medical Economics speaks with Ronald Epstein, M.D., FAAHPM, professor of family medicine and palliative care at the University of Rochester and author of "Attending: Medicine, Mindfulness and Humanity."

Their conversation explores how mindfulness shows up in everyday clinical practice — not as meditation or another box to check, but as attention, curiosity, presence and communication in the exam room. Epstein reflects on burnout, the limits of productivity-driven care and why small moments of awareness can improve patient relationships, teamwork and professional satisfaction.

They also discuss mindfulness beyond the individual clinician, including its role in teams, leadership and organizational culture, as well as where tools like artificial intelligence (AI) may support — but never replace — human connection in medicine.

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Music Credits:
Crystal Grind by NISO - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Cold open
What patients say they want most from a doctor visit.

0:23 — Intro
Austin Littrell introduces the episode and the Practice Academy note.

1:03 — Interview begins
Melissa Lucarelli introduces Ronald Epstein and frames the conversation.

1:53 — Burnout and dissatisfaction
Why physicians and patients are both struggling with the system.

2:30 — The four foundations of mindfulness
Attention, curiosity, beginner’s mind and presence.

3:45 — Relationships before prescriptions
Why feeling understood matters as much as treatment.

4:25 — Curiosity in long-term care
Staying engaged with patients over years and decades.

5:20 — Beginner’s mind and the clinical gaze
How expertise can both help and limit perception.

6:25 — Defining presence
A story from the emergency department.

7:58 — Learning from missed details
What early experiences taught Epstein about attention.

10:56 — Seeing the disease, missing the person
A lesson from inpatient rounds.

11:54 — A turning point with electronic health records
What a patient taught Epstein about listening.

13:07 — A simple practice that changed visits
Why delaying the computer improved care.

14:41 — Mindfulness and malpractice risk
Why insurers care about communication.

15:55 — “I don’t have time for mindfulness”
Small practices that take seconds, not hours.

17:54 — Finding beauty during COVID-19
Staying present in bleak moments.

19:24 — Mindfulness in teams
Shared purpose in high-risk environments.

20:14 — Applying mindfulness in daily practice
Lucarelli reflects on what’s worked for her.

21:12 — Meditation and other paths
Mindfulness beyond sitting on a cushion.

22:30 — Emotional regulation in difficult encounters
Responding instead of reacting.

23:01 — Organizational mindfulness
Why teams and culture matter.

25:10 — Artificial intelligence and presence
Where AI helps — and where it doesn’t.

29:13 — Communication training with avatars
Using technology to improve listening and clarity.

31:02 — Can mindfulness fix a broken system?
The role of leadership and organizational change.

37:35 — Productivity and value-based care
Why throughput isn’t the same as health.

39:32 — Medical education and survival skills
What training still misses.

42:27 — If Epstein were rewriting the book today
Leadership, community and collective intelligence.

46:38 — Burnout as a long-standing reality
What’s systemic and what’s intrinsic to medicine.

47:34 — Final reflections
Why mindfulness belongs in education, culture and leadership.

48:08 — Outro
Wrap-up, subscription reminder and Practice Academy note.