I learned a good lesson in doctoring from Paul McCartney. Sir Paul, if we want to get formal about it. My wife and I went to one of his shows, and aside from re-living the soundtrack of our lives, we also were struck by how fresh and personal the concert felt. If you consider how many times he’s played those songs and that there were eighteen thousand people in the venue, fresh and personal is quite an accomplishment.

How many times do you think he’s played and sung Yesterday? A gazillion? Two gazillion? And yet he performed it tenderly, with as much feeling and soul as if he had written it the previous week. He played every song with enthusiasm and obvious enjoyment.

At one point McCartney asked us to give him a moment to “take you all in.” He just stood toward the back of the stage and scanned the room and nodded and smiled at the responses from the rear, sides, and floor of the huge arena. It felt like he was saying, “I’m glad to be here with each of you.”

Sir Paul personalized the show with stories and jokes that he told as if he were speaking to just one or two people. He told Rolling Stone in July 2017, “The truth is when I do the show, I feel like I’m kind of talking to someone like me in the audience, even though you’re at the back of the hall, we try and bring the intimacy to you…it’s me, one-on-one, with every member of the audience.”

He does achieve that. But here’s the most amazing part: when I saw the show, he’d been touring it for a year and a half around the world. And it still sounded fresh. Sir Paul was fully engaged with us. How does he do that, show after show, and what can we learn from him?

After all, much of what we do is repetitive, too. The same history, the same basic physical exam, the same lab work? How many times do you think you’ve checked a patient’s blood pressure? Thousands, probably. How many labs have you checked? Sutures tied? EKGs read? So how do we keep our performance fresh?

I thought I’d ask an expert, British actor and Olivier Award-winning director Andy Nyman. (Sir Paul was not available.) Andy is one of those great working actors who has been steadily employed for thirty years. He has extensive film and television credits and, very important for our purposes, has acted in long-running shows in London’s West End. I asked him how he keeps his performance fresh every night when he’s been acting in a play for several months.

“The key and the simple answer is always listening,” Andy said. “It’s about listening to the person who’s opposite you and not knowing what they’re going to say next even though you’ve heard it a thousand times, because if you are genuinely listening, you can genuinely respond.”

Listening genuinely and responding genuinely. The basic key to the doctor-patient interaction. Andy also offered ways that physicians can stay fully present. “How do you stay in the moment? By remembering that every patient is a new audience. Reminding yourself before the [patient] walks in that they’re coming in for your performance and you’re about to go on stage and that this [doctor’s visit] is of massive importance to them. So you ask yourself, ‘Am I in character? Do I feel in the moment? Am I ready to enter into that scene?’”

Just as the actor must remember that every night there is a new audience and that no two audiences are the same, we can remind ourselves that no two patients are the same, even if they have the same medical problems. Every patient encounter becomes fresh and new.

However, Andy added, “Being in the moment and forcing yourself to be in the moment is a really, really difficult thing to achieve. On stage you have to disengage from everything else going on in your mind and just listen to what the person is saying. So I have always tried to put little tricks into my performances that allow me to be in the moment and allow me to be as present as I can be.

“One of the things I’ve always loved to do as a performer is what I refer to as being ‘on my toes.’ It requires making a physical shift. If you walk or stand naturally, you have your weight back a bit, on your heels. It makes you feel very grounded, but it also allows you to relax. If you shift your physical weight forward and take some of the balance off your heels and onto your toes, it puts a real spring in your step. It sounds like a cliché, but there’s real life in it, and it literally forces you to be physically present.”

This practice could be a problem for us since it’s preferable that we sit when talking to patients. However, you can achieve the same shift in balance and attentiveness simply by leaning forward in your chair.
Andy surprised me by mentioning something else that helps him keep his performances fresh: gratitude. He brought it up when I mentioned how Paul McCartney had taken time to appreciate the audience.

“He’s one of the wealthiest people in the world, one of the most successful people in the history of song writing and yet he’s still grateful and excited. ‘Oh, my god, look at the amount of people who are here to hear my songs.’

“I struggle with actors who aren’t grateful and excited. I’m thirty years into my career and every time I do a job, I can’t believe it, I’m excited, and I love it. That’s one of the things that keeps it very, very fresh as an actor, even in a long run. I’m doing what I dreamed of [as a kid] every time I walk through the stage door. And for doctors it means reminding yourself every time you walk into the hospital or office…”
How privileged we physicians are to do what we do. How this is what we dreamed of as kids. And how in the midst of the repetitiveness and the challenges and the hassles of daily practice, how fortunate we are that this is how we are spending our energies and lives, in the service of others. One “audience” at a time.