The DOI matches its Crossref record; 13 of the 13 references it cites were found in a registry or an index.
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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“Cassel defines suffering as a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.(4) Physicians are primarily trained to find out what is wrong with the body in terms of disease or pathophysiology.”
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Krikorian, A., & Román-Calderón, J. P. (2014) · Palliative & Supportive Care · doi:10.1017/s1478951514001102 · Cited by 5
“Even though several definitions of suffering have been offered (Fordyce, 1988; Cassell, 1991; 1999; Bayés et al., 1996; Loeser & Melzack, 1999; Chapman & Gavrin, 1999; van Hooft, 2000; Krikorian & Limonero, 2012), few attempts at developing theoretical models exist (Kahn & Steeves, 1995; Dildy;…”
BackgroundMorrissey, M. B. Q., & Whitehouse, P. J. (2016) · Journal of Theoretical and Philosophical Psychology · doi:10.1037/teo0000039 · Cited by 5
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Hanna, S. A., Marta, G. N., & Santos, F. S. (2011) · Revista da Associação Médica Brasileira (English Edition) · doi:10.1016/s2255-4823(11)70116-3 · Cited by 5
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Sánchez, D. G., García, R. G., López‐Medina, I. M., & Cuesta‐Vargas, A. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027524 · Cited by 5
“In this context, the prevention and relief of suffering are crucial to the wellbeing and the quality of dying and death of patients and families facing life-threatening diseases.(2) 3 According to Krikorian and Limonero, suffering is ‘a multidimensional and dynamic experience of severe stress that occurs when there is…”
BackgroundHow Accurate Are Health Care Workers' Perceptions of Patient Suffering? A Pilot Study
Lesho, E. P., Udvari-Nagy, S., Rókusz, L., Saullo, L., & Rink, T. (2006) · Military Medicine · doi:10.7205/milmed.171.8.774 · Cited by 5
Episodes of relationship completion through song in palliative care.
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Lanken, P. N., Terry, P. B., DeLisser, H. M., Fahy, B. F., Hansen-Flaschen, J. H., Heffner, J. E., Levy, M. M., Mularski, R. A., Osborne, M. L., Prendergast, T. J., et al. (2009) · PULMONOLOGIYA · doi:10.18093/0869-0189-2009-0-1-11-31 · Cited by 4
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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