Suffering
What?
- Suffering involves distress or hardship that may be physical, psychological, social or spiritual. It can disturb relationships, familiar roles and the story a person tells about their life. A flourishing-based account attends to the gap between the goods a person needs and what they can now experience or achieve.
- Pain and suffering are closely related but distinct. Pain does not explain every form of suffering, and its significance differs between people. Understanding suffering requires attention both to personal experience and to losses of goods or capacities such as health, relationship and virtuous activity.
So What?
- Relieving suffering is a major aim of medicine, but bodily treatment alone may miss its other dimensions. A patient may need recognition, companionship and help understanding changes in their life; clinicians should resist reducing the person’s distress to physical symptoms.
- Meaning in suffering can be difficult to find and cannot be imposed by a physician. When suffering cannot be removed, sustained presence and acknowledgment remain meaningful care. The physician and learner may also need support in responding to what they witness.
Now What?
- Recognize suffering, explore its quality and expression, and work toward a shared understanding with the patient. Ask about changes in relationships, roles and hopes, and about the gap between their present experience and the life they long for. Listen to their words and stories.
- Practice responding to physical, psychological, social and spiritual suffering with appropriate treatment, compassion and continued presence. Where relief is limited, accompany the person. Reflect with trusted colleagues or mentors on the virtues needed by patient and clinician, including hope, patience, fortitude and generosity.
Clinical Case
“I don’t have time for questions now, we’re so behind”, your preceptor lets out a long sigh as she sits back down at her computer to type out the beginnings of a note and put in a few orders. Your first few weeks at this family medicine clinic have been challenging, but not in the ways you expected. There have been few difficult conversations or grave diagnoses, instead you are mostly managing conditions like diabetes and hypertension. You’ve begun to wonder how much the medications help. It has been hard to connect with your preceptor as well. While she is kind to you at the beginning of the shift, she hardly makes any time for conversation and is always concerned about “the work flow” and “being behind”. You have begun to wonder whether she really enjoys her practice.
From down the hallway you hear a high pitched shriek, the pediatric 1:45 appointment apparently has had bad experiences at the doctor in the past. After a few minutes the nurse comes in reporting that the patient won't even let her get vital signs. You nod, even though you have been hearing the 3 year old’s defiance this whole time. “Fine, just get to the screening questions, we are so behind" your attending says sharply without looking away from her screen. You grab your laptop and follow the nurse in to get a history from the patient and their family.
You find the room in disarray, the paper has been torn off of the examination table, the
otoscope hangs from its cord in the corner, and the parents are trying to coax your patient out from behind the exam table with a youtube video. After bringing some order to the situation you begin to ask the parents about why they came in. Mom describes that he has been waking up and vomiting in the night, having intense stomach pain, and goes days without having a bowel movement.
After reporting to your attending, you walk back in together to find a similar scene as before. Your attending clears her throat and sits down at the computer. The parents turn around, embarrassed, leaving their child behind the examination table. The conversation progresses with the patient’s behavior occasionally interrupting the visit. During the behavioral screening questions your attending asks whether they have begun timeouts. The parents reply that they have tried but “he always seems to get out of his room when we put him there for timeout”. Your attending suggests a meeting with a pediatric behavioral specialist. During the visit it becomes clear that the patient will need to see two other specialists and have his vaccines. You see the look on the parents' faces as they imagine this ordeal again and again. After some deliberation they agree... what else is there to do?
Discussion Questions
- Who is suffering here: the child, parents, clinician or learner? What different forms does it take?
- How does alleviating suffering differ from relieving pain?
- How should we respond when someone cannot find meaning in suffering?
- What do you experience when faced with others’ suffering, including in this case?
- What would it mean to acknowledge their suffering through words, actions and continued care?
Sources
Sources: LearnWorlds lessons and the earlier Canva one-pager.