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.

The Meaning Of Healing: Transcending Suffering

“…By forging connexional relationships, grounding treatment choices in the person rather than the disease, maximizing function, and actively minimizing suffering, physicians strengthen patients with the goal of maintaining intactness and integrity. 48,[86][87][88] The requisite clinical methods, empathy, and communication skills for fostering connexional relationships are known and teachable, [89][90][91][92][93] and the necessary attitudes and insight are being discussed. [94][95][96][97] Still, research regarding the detection and management of suffering is sorely needed.…”

Vida e morte na atenção primária à saúde: reflexões sobre a vivência do médico de família e comunidade ante a finitude da vida

“…5 Nesse sentido, cabem reflexões sobre sofrimento e morte, sob perspectivas existenciais, sociais, religiosas e pessoais. 6 Essa construção dialógica considera a experiência de vida da pessoa e familiares, traz à tona valores e crenças, e exige o olhar sobre a dimensão espiritual do ser humano. 7 Dada sua importância nos cuidados paliativos, cabe trazermos o conceito de espiritualidade.…”

“…12 A dificuldade dos profissionais de saúde lidarem com sua dimensão pessoal é natural, contudo, corre-se o risco de que as questões sobre sofrimento e terminalidade sejam negligenciadas. 6 Outro aspecto preocupante é o risco de sobrecarga profissional. Dearmond 13 descreve que já são bem documentados burnout e fadiga de compaixão em profissionais paliativistas.…”

Suffering, Meaning, and Healing: Challenges of Contemporary Medicine

“…38 The diagnosis of suffering is uniquely dependent upon the clinician's subjective experience, making physicianhealers "strange instruments." 51 To manage the shared vulnerability of the close interpersonal relationships of healing, physician-healers must be mindful so they can balance their personal responses to patients with their professional presentation. 52 Not allowing their own feelings and views to cloud a clear appreciation of the patient's experience permits physician-healers to affi rmatively witness the patient's suffering.…”