Cited by 329Empathy and Medical EducationMedicine, History, and PhilosophyPatient-Provider Communication in Healthcare

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Diagnosing Suffering: A Perspective

Cassell, Eric J.·1999·Annals of Internal Medicine

DOI 10.7326/0003-4819-131-7-199910050-00009

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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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Grue, J. (2020) · doi:10.23865/noasp.96.ch8
De to veiene til dødshjelp
Kleiven, D. J. H. (2020) · doi:10.23865/noasp.96.ch7
Legalisering af dødshjælp – den indirekte afvisning
Hartling, O. J. (2020) · doi:10.23865/noasp.96.ch5
Psykiatri och dödshjälp
Román, S. (2020) · doi:10.23865/noasp.96.ch11

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
DOI: 10.7326/0003-4819-131-7-199910050-00009
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
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
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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