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Accepted: 13 August 2024

First Online: 20 September 2024

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: The author declares no competing interests.

: ¹ Attention, in the context of this discussion, can be thought of as states of presence, focus, and incorporation of selected clinical information within the care environment (Kissler et al., ). Philosopher Wayne Wu develops a helpful discussion of the definition and character of attention as a psychological and metaphysical phenomenon in his 2014 book. There, he cites and then systematically analyzes William James’ assertion:“Everyone knows what attention is. It is the taking possession by the mind, in clear and vivid form, of one out of what seem several simultaneously possible objects or trains of thought. Focalization, concentration, of consciousness are its essence. It implies withdrawal from some things in order to deal effectively with others, and is a condition which has a real opposite in the confused, dazed, scatterbrained state which in French is called distraction, and Zerstreutheit in German” (James, <i>The Principles of Psychology,</i> 1890, as cited in Wu, ).Simone Weil extends this cognitive/psychological characterization of attention to include ethics, spirituality, and personal change.² In particular, narrative medicine addresses ways that attention can be developed as a capacity for those involved in healing professions, honed through reciprocity and through representations of what is encountered in the clinic:“Attentive listening is the core of the practice, far more important than exactly what words are used. It is here in the reception of the patient’s response that the narrative aspects of the healthcare encounter occur and that all the skills of narrative medicine are put into practice. Philosopher and activist Simone Weil writes, ‘The capacity to give one’s attention to a sufferer is a very rare and difficult thing; it is almost a miracle; it <i>is</i> a miracle.’ Never fully achieved, this state of attention is, nonetheless, what the nurse or social worker or chaplain or physician seeks to attain” (Charon , 293)The conceptualization of attention also has roots in Weil’s thought along with several other philosophers and literary scholars including Emmanuel Levinas, Martin Buber, Walter Benjamin, and Henry James (Charon, ).³ The authors write that rather than attentions imply as focalizing on needs, “We argue for a broader view, in which attentiveness is not only the first step in care, but also a good in itself. Attentiveness makes people flourish, it makes them do well” (Klaver and Baart , 689).⁴ In his book <i>The Finest Traditions of My Calling</i>, psychiatrist Abraham Nussbaum investigates the history of medicine and several movements oriented toward its renewal. He writes, “In contemporary medicine, the underlying problem is that we see the wrong things or, rather, not all of the right things when we look at patients…even when physicians and nurses and paramedics work together as a team, even when they follow an evidence-based script in pursuit of consistent outcomes, the care they offer is often dehumanizing.” As an alternative he proposes that cultivating a new vision for patients and care, which involves learning “how to attend to patients as fellow creatures,” will contribute to “renewed vision for medicine” (Nussbaum , 5–9).⁵ This discussion of health systems is rooted in the healthcare context of the United States, and it is important to acknowledge that the practice of clinical medicine is varied and both context- and culture-specific. Nevertheless, this section addresses some general trends that emerge over the course of personal experience and review of the literature. The heterogeneity of medicine and opportunities to create smaller cultures within the larger interacting cultural landscapes that medicine inhabits are crucial to the innovations that we might propose after reading Weil.⁶ For an excellent discussion of the state of quality improvement with respect to these concerns, see the series of articles by Lisa Rosenbaum in the <i>New England Journal of Medicine</i> titled <i>Metric myopia</i>; <i>Peers, professionalism, and improvement</i>; and <i>Reassessing quality assessment</i> (Rosenbaum , , ).⁷ Sociologist Annemarie Mol discusses specific ways that the complexities of illness and interpersonal interaction create a need for carefully calibrated interactions with medical systems and technology in <i>The Logic of Care</i> ().⁸ Weil had a prolonged and thoughtful engagement with Marx’s work throughout her life, and while scholars differ on the degrees to which her thought is compatible with Marxist ideas, broadly, she drew inspiration from Marxist critiques of labor and alienation while taking an alternative approach to potential solutions. Weil rejects force and revolution as a means of transforming the social order, and labor ultimately takes on a distinct spiritual and existential importance in Weil. Further discussions of points of intersection and divergence between Weil and Marx include Radzins and Noël-Lemaître and Ruzza, .⁹ Legal scholar Ifeoma Ajunwa writes in the book <i>The Quantified Worke</i>r, “Now, it is not merely the job task that is being quantified, but it is also the worker’s health through workplace wellness programs, the worker’s mental state through personality job tests, and the worker’s social behavior through workplace surveillance and the monitoring of social media” (12).¹⁰ This approach informed a recent scoping review on clinician attention in the clinical environment (Kissler et al., ), and while the review focuses on metrics and overarching concepts of attention from a quality improvement standpoint, it acknowledges the importance of guiding theory and incorporation of concepts from outside of medicine, including philosophical understandings of attention such as Weil’s.¹¹ In an essay about the self-emptying inherent to Weil’s (and Iris Murdoch’s) ethical vision, Mark Freeman writes, “The musician—the blues or jazz musician, for instance—who is most able to improvise freely, to really venture forth, is the one who has most thoroughly mastered his or her craft and is able to draw on his or her ‘diverse knowledge’ and run with it” (Freeman , 165).¹² The connections between Weil, Murdoch, Polanyi, and technical excellence are explored in detail in Matthew Crawford’s book on attention <i>The World Beyond Your Head</i> ().¹³ Though a detailed discussion of the ethical implications of Weil’s ideas in the clinical setting is beyond the scope of the current paper, it is important to note that throughout her body of work, Weil situates the call to attention as an ethical one oriented toward the other. Her work bears important similarities with the philosophy of Emmanuel Levinas, and rather than rights-based or principle-based ethics, both thinkers develop, in different but complementary ways, encounter-based ethics that has implications both to individual clinical encounters and system-based improvement efforts. Some characteristics of this ethical engagement include renunciation of force, the diminishment (or, in Weil, “decreation”) of the self, listening and silent reception of the plight of the other, and the pre-eminence of the other. In addition to Murdoch’s <i>Sovereignty of Good</i>, Maier (), Thomas () and the chapter “Angry Angels” in Rose () provide good starting places for further reading.¹⁴ Fyodor Dostoevsky is concerned with this distinction throughout <i>The Brothers Karamazov</i>, in sections including the dialogue between Father Zosima and the pilgrims seeking justification and reward for their virtuous acts, Ivan’s story of John the Merciful whose actions were motivated by duty rather than love, and Alyosha’s embodied, incarnational response to Ivan’s famous rationalist critique in <i>The Grand Inquisitor</i>. Weil was a close reader of Dostoevsky.¹⁵ See, for instance, <i>Gravity and Grace</i>: “God can only be present in creation under the form of absence” (109).¹⁶ The poet Dana Gioia () writes, “Art is holistic and incarnate—simultaneously addressing the intellect, emotions, imagination, physical senses, and memory without dividing them…[it] is a form of knowing—distinct and legitimate—rooted in feeling and delight—that discovers, in the words of Jacques Maritain, “The splendor of the secrets of being radiating into intelligence” (30–34).