Who is the patient of attentive medicine?
 |
| Attentive medicine begins with an opening of the heart – when the patient says, “I am ready.” |
Who is the patient of attentive medicine?
Many people ask me: “Who is attentive medicine really for?”
This is not a theoretical question: it defines what can be expected of the patient, and what cannot be expected of this practice. Attentive medicine is not a shortcut to avoid conventional medicine, nor an alternative to vital treatments. It begins elsewhere.
A necessary clarification: the patient’s role and the place of vital treatments
It is essential to make clear that attentive medicine never begins with a refusal of conventional treatments. The resolution of symptoms is sometimes vital, and only conventional medicine can ensure survival and the minimal stability of the body. Without this biological safety, no attentive space is possible.
Attentive medicine is not an alternative, nor a shortcut to avoid care. It comes in addition, on another level: not to suppress, but to understand.
A matter of inner openness
“So, who is truly the patient of attentive medicine?”
To answer, I must first say who I am, the one who created it. Above all, I am someone who seeks to honour reality.
The reason I paid attention to my children’s symptoms was not to make them disappear, but because my children themselves mattered to me. And the same was true for me: I also paid attention to my own symptoms, because I mattered to myself. I wanted to understand us – together.
This is
what I ask of patients: an openness to take an interest in their bodies, not
merely in the hope that symptoms will go away, but to open to what they mean.
This openness is a form of self-respect, a way of honouring what the body
expresses.
Attentive medicine cannot be decreed. The family may be ready, the doctor may be ready, but if the patient says “I’m not ready,” then attentive medicine does not begin. It requires a personal disposition, a willingness to enter a deeper vulnerability–not only physical, but psychological and existential.
Example
1: Conventional Medicine (an Adolescent and His Liver)
A
19-year-old patient comes to the consultation with his father. For several
years he has lived with what medicine calls a “fatty liver.” His blood tests
show a sustained rise in transaminases, a sign of worsening.
When I
question him directly, he says he remembers nothing of his childhood and
prefers that his father answer for him.
The father
explains. Until the age of 10–11, his son was slim, without excess weight. At
that age, violent outbursts of anger begin, occurring especially at home when
the father is absent.
In response
to these outbursts, the family’s strategy was nutritional: give crisps and
sugar to soothe him. This calmed the crises but also established a harmful
habit, never questioned for what it might mean.
Around
13–14, another turning point. The adolescent becomes self-conscious about his
body and his weight. Out of shame about his appearance, he starts refusing
sport. At the same time, he discovers video games, which reinforce sedentary
behaviour. From there, weight gain becomes entrenched and the evolution toward
fatty liver becomes unavoidable.
The mother,
who is deaf, experienced these outbursts with particular fear. From a very
young age, the child had communication difficulties with her–repeated
frustrations that marked his daily life.
At age 7,
when the family sought help for a delay in his communicative development, no
one suggested that these difficulties might be linked to growing up with a
mother who does not hear, and therefore needing to invent another way to
communicate. The focus was only on making him “catch up” with his “delay.”
Later,
school noted that this young man struggled to project himself in time, past or
future. “I don’t remember anything from my childhood,” and “I can’t
project myself into the future,” he says. These elements, together with his
history of language difficulties and anger, led to a descriptive diagnosis: “autistic,”
made at age 10–11.
Were the
outbursts, at least in part, connected to this new “label”? “I don’t
remember,” replies the patient. The father had never asked himself the
question.
In
practice, this diagnosis did not open a search for causes, but it did have
administrative utility: it facilitated communication with the school and
enabled tailored educational support. Beyond that, it mainly froze the
understanding of this young man within a label.
Instead of
exploring the relational context and the meaning of his difficulties, the
observation was turned into an identity, folded into the causal haze often
proposed in conventional medicine. The patient and his family are then left to
guess what the diagnosis “means”–which they interpreted, like the vast
majority of families facing such a diagnosis, through vague explanations: “genetic,”
“structural”–even though no genetic test, scan, or blood test confirmed
any specific cause.
A diagnosis
descriptive at the outset thus became a cause in itself. “He is autistic”
replaced all the questions: Why this communication delay? Why these outbursts?
Why this absent memory, and why this inability to project himself?
Today, at
19, nothing has truly changed: outbursts still soothed with sugar and crisps;
shame and low self-esteem masked by video games; and he lets his father speak
for him. The search for causes remains blocked by the idea of a cause: a
descriptive diagnosis presented as causal–“he is autistic.”
In
conventional medicine, the trajectory is clear: we will monitor his liver,
refer to a Weight Management Clinic, and it could even go as far as bariatric
surgery. The logic is coherent: slow the disease’s progression, protect life.
But in
attentive medicine, another path could be envisaged–only if the patient himself
says, “I’m ready.” Ready to explore the meaning of his outbursts, his
relationship to memory and the future, his relationship with food, and the
longstanding frustration of communicating with a deaf mother. Here, however, he
explicitly says: “I’m not ready.” The father would like to understand.
But attentive medicine cannot proceed through the parent’s desire. It begins
only from the patient’s own openness.
This
example shows the limit of the conventional approach and what attentive
medicine could bring–but only if the patient engages. The two practices are not
opposed; they are parallel: conventional medicine ensures survival and
biological follow-up; attentive medicine explores, but only if the person is
open to it. Without this personal openness, attentive medicine does not take
place. It cannot be decreed: it requires an inner disposition.
Example
2: Attentive Medicine (a Naturopath and Her Hyperthyroidism)
A
naturopath contacts me five days after being diagnosed with autoimmune
hyperthyroidism. She is hesitant about undergoing treatment, wanting to explore the
meaning of what her body is experiencing: why her thyroid, the centre of her
vital energy, is being attacked by her immune system.
I reply: “Yes,
we can explore what, at the moment the body changed, in light of your life,
could explain this shift–in that place, in that way, at that moment. But if you
do not take your treatment, you will die.”
I also add
that as long as her body is in crisis–tachycardia, ocular discomfort, agitation–she
will not be able to enter an attentive reflection. Physical instability
prevents psychological clarity.
I followed
up in writing, and it was only once she assured me she was taking her treatment
that we were able to continue our attentive-medicine consultations.
Here,
conventional medicine secures life and physical stability, and attentive
medicine can then explore what may have led the body to this change.
Example
3: Opening to Attentive Medicine within Conventional Medicine
(a 50-year-old man, multiple chronic sufferings and drug dependence)
This man,
born in 1973, had been living for almost fifteen years with an accumulation of
difficulties: chronic low back pain with sciatica, health anxiety, depressive
episodes, professional burnout, relational and sexual difficulties, dependence
on opioids and antidepressants.
The back
pain was only the visible part of a broader picture, made of exhaustion,
losses, and a feeling of being trapped in a body and a life that no longer
responded.
I met him
at the beginning of 2023. At that time, he was consulting frequently. But, as you will see, the consultations quickly became less
frequent as he began a path of transformation – in his own way.
The
accumulation of diagnoses and treatments
An MRI in
2014 showed a lumbar disc herniation compressing the nerve root. In 2023, a new
MRI revealed a different situation: the initial herniation had disappeared, but
another disc protrusion had appeared, again causing compression.
The spinal
surgeon’s proposal did not suit him: he was not ready to accept the risks of
complication that had been explained to him. The patient refused, judging the
risks too great for him.
He then
settled into a medical spiral:
- opioids (tramadol, codeine,
combinations such as Zapain),
- long-term antidepressants
(citalopram, then sertraline up to 150 mg),
- repeated sick notes, reduced
function, restricted life.
Added to
this were professional burnout, relationship breakdown, family bereavements,
persistent health anxiety. The whole made up a heavy, medicalized, and deeply
painful picture.
The
turning point of attention
It is in
this context that an attentive space opened up – not outside conventional
medicine, but at its very heart, within the consultations.
Rather than
limiting myself to adjusting prescriptions, the approach consisted in listening
and naming:
- his health anxieties, by
revealing their deeper causes,
- his opioid dependence,
acknowledged without judgment, then worked on with him through a tapering
plan that he chose and directed,
- his prolonged use of
antidepressants, reframed in relation to the feeling of emotional
“numbing,” and the need to explore his affective life and what sustains it
in human beings more generally.
He said he
did not want professional psychological support: “I want to understand
myself alone.” I respected this choice, while clarifying that I was not
specialized in mental health – neither as a psychologist nor as a psychiatrist,
which he already knew. The rest of his journey would show what that meant.
In
parallel, other doors opened: walking in nature, swimming, taking up cycling
again, experimenting with physiotherapy; giving up caffeine, improving
hydration, protecting sleep.
And above
all, a decisive discovery: John Sarno’s work on psychosomatic pain particularly
resonated with him. Discovering that his back was also expressing a
psychological and emotional conflict profoundly transformed his relationship
with pain.
The progressive transformation
- February 2023: complete discontinuation of
tramadol and opioid combinations.
- September 2023: complete cessation of
codeine, which he had been taking daily for years.
- February 2024: gradual and complete
withdrawal from sertraline, after more than a decade of antidepressants.
By
2024–2025, he was no longer using antidepressants, opioids, or regular
analgesics. Even sildenafil, used for erectile difficulties, was no longer
necessary.
His
current state
Today, low
back pain still recurs at times, but it is experienced differently: no longer
as a blockage calling for a prescription, but as a signal he relates to his
inner tensions, which he soothes with exercise, rest, or attention to his
emotions.
Headaches,
which appeared in 2024, followed the same path: recognized as linked to stress,
they eased without medication.
That same
year, hypercholesterolemia was diagnosed. Once again, he chose an attentive
approach and took responsibility for it. Without resorting to statins, he
transformed his diet – eliminating processed foods, favoring simple and natural
nutrition – and replaced sugary and stimulating drinks with water. Combined
with the exercise he had already resumed, this change allowed him to normalize
his cholesterol.
He also
changed profession and now works in the field of mental health. He says
he functions better than he ever thought possible. He also describes more
present relationships with his children, a rediscovered ability to enjoy life,
an autonomy he thought lost.
What
this case shows
This
patient moved from dependence on multiple medications (analgesics, opioids,
antidepressants) to a life without regular prescriptions, guided by
understanding and attention.
Conventional
medicine played its part: diagnosing, proposing symptomatic solutions, and
offering them. What it had not offered him, however, was attention to the price
paid by drug dependence, and the opening toward other ways of looking at his
illness.
It was the
attentive opening, at the very heart of this conventional follow-up, that
allowed him:
- to recognize the role of the
psyche and life context in pain,
- to put an end to a heavy drug
dependence,
- to regain lasting vitality and
autonomy in managing his health, through attention to essential lifestyle
hygiene.
This case
illustrates that attentive medicine does not oppose conventional medicine: it
can emerge within it, when attention shifts toward understanding the causes of
symptoms rather than simply suppressing them.
The
patient who opens to attentive medicine
Attentive
medicine is not aimed at a particular “profile” of patient, nor at a specific
disease. It is not an alternative where conventional treatments would be
abandoned in favor of another approach.
The patient
who chooses attentive medicine actually assumes two forms of responsibility,
two ways of saying: “I matter to myself.”
- Preserving life. This means recognizing that
conventional medicine has a vital and irreplaceable role. When survival is
at stake, when the body is unstable, medications, surgery, and
examinations remain indispensable. Refusing this in the name of attentive
medicine would be a profound misunderstanding of what it is. This
responsibility is the very condition of the encounter: without secured
life, there is no possible space for listening.
- Understanding oneself. The patient who opens to
attentive medicine accepts to go beyond the simple hope that symptoms will
disappear: he chooses to be interested in what his body expresses, to
welcome the part of him that does not obey his desire, to encounter a
vulnerability that is not only physical. It is the vulnerability of being
able to say: “I don’t know why I have changed shape; but I am
interested, and I will share this vulnerability with a professional ready
to receive and support it.”
This
responsibility to vulnerability is not imposed: it arises from an inner
disposition. The patient must be able to say within himself: “I am ready.”
Neither the entourage nor the doctor can say it in his place.
Thus, the
patient of attentive medicine is the one who accepts both commitments in
parallel:
- to be responsible for
protecting his life with conventional care;
- to be responsible for
understanding himself, by exploring the meaning of what his body reveals.
It is in this double movement – survival and understanding, protection and openness – that attentive medicine can truly begin.
.jpg)
Comments
Post a Comment