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Diagnosing Suffering: A Perspective
Abstract
The alleviation of suffering is crucial in all of medicine, especially in the care of the dying. Suffering cannot be treated unless it is recognized and diagnosed. Suffering involves some symptom or process that threatens the patient because of fear, the meaning of the symptom, and concerns about the future. The meanings and the fear are personal and individual, so that even if two patients have the same symptoms, their suffering would be different. The complex techniques and methods that physicians usually use to make a diagnosis, however, are aimed at the body rather than the person. The diagnosis of suffering is therefore often missed, even in severe illness and even when it stares physicians in the face. A high index of suspicion must be maintained in the presence of serious disease, and patients must be directly questioned. Concerns over the discomfort of listening to patients' severe distress are usually more than offset by the gratification that follows the intervention. Often, questioning and attentive listening, which take little time, are in themselves ameliorative. The information on which the assessment of suffering is based is subjective; this may pose difficulties for physicians, who tend to value objective findings more highly and see a conflict between the two kinds of information. Recent advances in understanding how physicians increase the utility of information and make inferences allow one to reliably use the subjective information on which the diagnosis and treatment of suffering depend. Knowing patients as individual persons well enough to understand the origin of their suffering and ultimately its best treatment requires methods of empathic attentiveness and nondiscursive thinking that can be learned and taught. The relief of suffering depends on physicians acquiring these skills.
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“Because suffering is a personal experience, only the affected individuals can assess whether it is intolerable.20,21”
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Neuwirth, Z. E. (2002) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2002.tb04291.x · Cited by 34
Suffering, psychological distress, and well‐being in Indonesia: A prospective cohort study
Ho, S., Cook, K. V., Chen, Z. J., Kurniati, N. M. T., Suwartono, C., Widyarini, N., Wong, P. T. P., & Cowden, R. G. (2022) · Stress and Health · doi:10.1002/smi.3139 · Cited by 33
“A person's experience of suffering may evolve from a minor, manageable burden to become an intense, pervasive source of distress that can disrupt salient aspects of their life (Black & Rubinstein, 2004; Cassell, 1999).”
BackgroundA novel Scale to Assess Palliative Care Patients' Experience of Feeling Heard and Understood
Edelen, M. O., Rodriguez, A., Huang, W., Gramling, R. E., & Ahluwalia, S. C. (2022) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2022.01.002 · Cited by 32
Sánchez, D. G., García, R. G., Vargas, A. I. C., & Pérez‐Cruzado, D. (2020) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2020.103704 · Cited by 31
Fromme, E. K., & Billings, J. A. (2003) · JAMA · doi:10.1001/jama.290.15.2048 · Cited by 30
“At such times, we may be able to offer nothing more than our presence.(71) Physicians typically protect themselves from the frightening and painful aspects of patient care through some degree of professional detachment or objectivity,(72) a focus on problem solving, and by maintaining boundaries or setting limits.”
BackgroundSpiritual Issues in Surgical Palliative Care
Hinshaw, D. B. (2005) · Surgical Clinics of North America · doi:10.1016/j.suc.2004.11.002 · Cited by 30
“Start by asking, ‘‘Are you suffering?’’ [20].”
BackgroundIs “quality of care” being mislabeled or mismeasured?
Feinstein, A. R. (2002) · The American Journal of Medicine · doi:10.1016/s0002-9343(02)01043-4 · Cited by 30
Is Suffering a Useless Concept?
Nelson, R. H., Kious, B. M., Largent, E. A., Moore, B., & Blumenthal‐Barby, J. (2024) · The American Journal of Bioethics · doi:10.1080/15265161.2024.2353799 · Cited by 29
Wouters, E., Reimus, J. L. M., van Nunen, A. M. A., Blokhorst, M. G. B. G., & Vingerhoets, A. J. J. M. (2008) · Behavioral Medicine · doi:10.3200/bmed.34.2.65-78 · Cited by 29
The Accuracy of Physicians’ Perceptions of Patients’ Suffering: Findings From Two Teaching Hospitals
Lesho, E. P., Foster, L., Wang, Z., Sarmiento, D. M., Dennison, S., Vahey, M., Nolan, E., & Smalls, C. (2009) · Academic Medicine · doi:10.1097/acm.0b013e31819facf1 · Cited by 29
Family Perceptions of Worry, Symptoms, and Suffering in the Dying
Hickman, S. E., Tilden, V. P., & Tolle, S. W. (2004) · Journal of Palliative Care · doi:10.1177/082585970402000105 · Cited by 29
“Direct questioning about fears and worries, in addition to thorough symptom assessment, is critical to adequately addressing suffering (6,46).”
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Auret, K. A., & Schug, S. A. (2013) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2013.10.007 · Cited by 28
Palliative care: the need of the modern era
Chan, K. (2018) · Hong Kong Medical Journal · doi:10.12809/hkmj187310 · Cited by 28
Bustan, S., González‐Roldán, A. M., Schommer, C., Kamping, S., Löffler, M., Brunner, M., Flor, H., & Anton, F. (2018) · PLoS ONE · doi:10.1371/journal.pone.0199814 · Cited by 27
Chronic Struggle: An Institutional Ethnography of Chronic Pain and Marginalization
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Bridging the discursive gap between lay and medical discourse in care coordination
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“2010) and ‘what is wrong with the body’ (Cassell 1999), rather than as a personal, experiential narrative reflecting the patient’s ‘life-world’ (Mishler 1984), that is, the patient’s contextualised experience of illness (Greenhalgh 1999), its impacts on her everyday life, and her preferences, feelings and beliefs abou…”
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“According to Cassell (1999) suffering is “a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.””
BackgroundEmpathy, Emotion, and Ekstasis in the Patient–Physician Relationship
Pembroke, N. F. (2006) · Journal of Religion and Health · doi:10.1007/s10943-006-9071-4 · Cited by 27
“The physician tends to focus on the body and disease, the patient on illness and suffering ( Cassell, 1999, 2003; Lesho, 2003; McWhinney, 1998; Mead & Bower, 2000; Toombs, 1992).”
BackgroundInfluentialUomoto, J. M., & Williams, R. M. (2009) · Rehabilitation Psychology · doi:10.1037/a0016907 · Cited by 27
Suffering in children: opinions from parents and health-care professionals
de Weerd, W., van Tol, D. G., Albers, M. J. I. J., Sauer, P. J. J., & Verkerk, M. A. (2014) · European Journal of Pediatrics · doi:10.1007/s00431-014-2440-1 · Cited by 31
Hypnosis and Existential Psychotherapy with End-Stage Terminally Ill Patients
Iglesias, A. (2004) · American Journal of Clinical Hypnosis · doi:10.1080/00029157.2004.10403600 · Cited by 26
Moore, R. J., & Spiegel, D. (2000) · Integrative medicine · doi:10.1016/s1096-2190(00)00003-2 · Cited by 26
Santina, C. D., & Bernstein, R. H. (2004) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2004.07.010 · Cited by 26
“’’ The human experience of suffering is unique to the affected person, and to alleviate suffering, physicians must be vigilant about the multiple sources of suffering [4].”
Background
Metadata
- Authors
- Cassell, E. J.
- Affiliations
- Cornell University (US)
- Corresponding author
- Cassell, Eric J.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1999-10-05
- Volume
- 131
- Issue
- 7
- Pages
- 531-534
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2049646510
- Cited by
- 329
- References
- 13
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 13 · 2023: 9 · 2022: 11 · 2021: 17 · 2020: 21 · 2019: 11 · 2018: 15 · 2017: 20 · 2016: 8 · 2015: 11 · 2014: 11 · 2013: 12 · 2012: 16
- FWCI
- 4.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Social Sciences › Arts and Humanities › History and Philosophy of Science › Medicine, History, and Philosophy
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- suffering, palliative care, dying patients, patient distress, physician-patient communication, empathic listening, subjective information, fear, meaning of symptoms, physician empathy, patient-centered care
- MeSH terms
- Clinical Competence, Humans, Pain, Physician-Patient Relations, Stress, Psychological, Terminally Ill, Pain Management
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