Pain and Suffering

“Suffering ceases to be suffering in some way at the moment it finds a meaning”      Viktor Frankl

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has”      William Osler

 

Back in the 1990’s when pain was the newest vital sign, physicians were mandated to treat it, often with powerful medications and without truly understanding the cause and significance of the pain for individual patients.

Plato and Aristotle didn’t include pain as one of the senses, but described it as an emotion. The word “pain” is derived from Poine or Poena, the Greek goddess of revenge and the Roman spirit of punishment. Her name is also the origin of the word penalty.

Of course, pain was never measured objectively in antiquity or when it became a “vital sign” a couple of decades ago. It still can’t be measured, which makes it no more of an objective clinical sign than someone guessing their temperature without a thermometer.

“Pain and Suffering” is a legal constellation that equates the significance of the two afflictions; doctors, however, have wanted to think of the two as separate, one or the other, treated differently. In many instances, doctors treated only one – the one we call pain – and skirted around the other. We have pain specialists, but perhaps only end-of-life care formally addresses suffering; it is seldom a topic in everyday medicine.

How many times, when a patient has said “I hurt” have I asked “where” instead of “how” or “tell me more”, assuming the Chief Complaint is physical.

How many patients with chronic pain are unrelieved by our usual pain medications? And how many of them receive the label “psychosomatic”, but little help from their doctors?

A few weeks ago, I came across a short piece by Dr. Thomas H. Lee in The New England Journal of Medicine about suffering. I have continued to think about it ever since.

I think medicine embraced pain assessment and pain treatment in a way that overcompensated for our ineptitude at mitigating suffering. Even as we treat patients’ pain, we sometimes cause suffering through the dehumanizing way our clinics and hospitals work.

Eric Cassell describes suffering as something that happens when our personhood is threatened. Sometimes physical pain, disability or the threat of dying is the cause of suffering, but sometimes the threat to personhood is loss in other spheres. In order to alleviate suffering, physicians need to understand something about the nature and meaning of this threat.

Doctors in our era are trained to treat diseases. We are not often formally trained to explore the person with the disease; this is something we are left to discover on our own, when the disease paradigm doesn’t seem to fit the patient we are trying to help.

The movement we now call “narrative medicine” is focused on the subjective meaning of disease and suffering. It offers a way out of the mechanized mindset of evidence-based medicine that is built solely around the lowest common denominators of diagnoses and treatments. The corporate-scientific medicine of today dismisses the statistical “outliers” and individual variations between patients in its efforts to help the greatest number of individuals, instead of each particular patient in the physician’s exam room.

Doctoring is a personal calling, built on personal relationships. Even statistical outliers deserve health care that works for them, and suffering can never be understood or mitigated without first seeking knowledge of the suffering person’s own fears and beliefs.

Eric Cassell writes:

“The doctor-patient relationship is the vehicle through which the relief of suffering is achieved. One cannot avoid ’becoming involved’ with the patient and at the same time effectively deal with suffering.”

How many doctors are comfortable getting that involved? And how many health care organizations see that as the role of their physicians?

2 Responses to “Pain and Suffering”


  1. 1 Christina December 9, 2013 at 4:59 am

    Thank you for such a thoughtful post.

  2. 2 Michael Yudez,DO December 17, 2013 at 3:22 am

    Relief of suffering by caring lessens the need for treatment of the pain


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s




Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Bookmark and Share

Mailbox

contact @ acountrydoctorwrites.com

RSS A Country Doctor Reads:

  • The Call Within the Call
    “We all go into professions for many reasons: money, status, security. But some people have experiences that turn a career into a calling. These experiences quiet the self. All that matters is living up to the standard of excellence inherent in their craft.” These words by The New York Times columnist David Brooks, in a […]
  • A Crazy Old-School Physician
    A post by Suneel Dhand on KevinMD asks the question who is crazy – the elderly physician who knows his patient’s history by heart, or today’s young doctors, who know the computer better than their patients: Then there’s the reality that his generation represents exactly what a personal physician should be. A solid physician with […]
  • What Can Doctors Learn from Teachers?
    An article in The New York Times about Doug Lemov’s book “Teach Like a Champion“ made me think more deeply about what to do with outcomes measures in health care. Lemov has analyzed how successful teachers teach, measuring how long they wait for students to answer questions to how much eye contact they have to […]
  • The Difference Between Care and Cure
    My wife ordered a book a few weeks ago by Henri Nouwen, called “Bread for the Journey”. It was published posthumously and contains daily reflections. Nouwen is perhaps best known for his writings about the “wounded healer”. This morning over coffee, Emma asked me to look at today’s reflection, titled “Care, the Source of All […]
© A Country Doctor Writes 2008-2015. Unauthorized use and/or duplication of this material without express and written permission is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given.