Remember how you spent hours and hours sitting at the piano? Or think about how you spent hours and hours practicing for a particular sport or dance or play. Maybe you spent all kinds of time preparing to give a speech or studying for a big test.

It is all about practice: the repetitive re-enactment of an act. Moms everywhere put the prescribed minutes on the kitchen timer. Kids universally try to negotiate the least amount of time they must put in. Coaches repeatedly blow their whistles or bark out drills. Directors, teachers, instructors and conductors likewise advise their charges to practice.

Parents or total strangers come up and joke that what I do as a physician is called practicing medicine.

The idea of practice has taken on new meaning since I have been trying to increase my power of attention. Attention is one of those skills we attribute to the pre-frontal cortex in our brains. This is the area that houses intelligence that we call "executive function." It includes different types of smarts — from knowing multiplication tables or dates in history.

"Executive functioning involves activating, orchestrating, monitoring, evaluating, and adapting different strategies to accomplish different tasks. ... It requires the ability to analyze situations, plan and take action, focus and maintain attention, and adjust actions as needed to get the job done." says Sheldon H. Horowitz, director of professional services at the National Center for Learning Disabilities, which is my emphasis.

We often say to our kids, "You are not paying attention." Other parents drag their children to the pediatrician's office because they are failing school. They walk out with the diagnosis of attention deficit disorder.

Unfortunately, lack of analyzing, planning, focusing or maintaining attention show up when someone is unsuccessful in various aspects of their life.

Perhaps, they are always looking for work because they could not stick with a job. Maybe they drop out of school because it was boring; what they really are saying is that they cannot pay attention.

Attention, like playing the piano, is a skill that can improve with practice. We can alter our brains with repetitive actions. The brains of musicians are different due to their hours of training; the neural centers that control fingers are enlarged in pianists or violinists. The spatial genius of London cab drivers required to memorize all the streets and back alleys of a whole city is visible on brain scans. It happens with the prefrontal cortex.

This transformation of our brains is called neuroplasticity. We learn all the time. On the positive side, we see a high level of executive intelligence in people who are successful and demonstrate self-discipline.

In essence, we practice all the time. So what are we practicing?

My father used to say that it was not practice that made perfect but correct practice that made perfect. Therefore, practice by itself may simply reinforce mistakes or the wrong answers. Hence, there is a need to practice the piece of music or answers on the page with the correct fingering or with the correct study of the right information.

What about the practice of social behaviors? I'm certain that if we were all to rehearse kindness, our brains would expand in our centers of altruism. That is why I am trying to practice attention. If we pay attention, we execute the first step of getting things done.

If we pay attention to another's plight, we are more apt to react to serve. If as a spouse we have more attention for a wife or husband, we increase our chances of being better. That is where correct practice makes perfect. If we improve our attention to focus on the little annoyances or the minor personality quirks, then our practice is misdirected. It would be like practicing to sing off key.

In meditation, one practices active focusing on breathing. Meanwhile, all around our minds thoughts are racing. The brain wanders off listening to inner voices. Harnessing our thoughts by gently returning them to correct practice and jettisoning judgments tagged to a memory increases the activity of the prefrontal cortex. It is practicing attention.

Someone has estimated it takes 10,000 hours to master a skill. I'm afraid even with practice I can't pay attention that long.

Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for 30 years, and an adjunct professor of pediatrics at the University of Utah. He can be reached at