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Research ArticleSpecial Communication

A Comprehensive Clinical Model of Suffering

William R. Phillips, Jane M. Uygur and Thomas R. Egnew
The Journal of the American Board of Family Medicine February 2023, jabfm.2022.220308R1; DOI: https://doi.org/10.3122/jabfm.2022.220308R1
William R. Phillips
From University of Washington, Seattle, WA. USA (WRP, TRE), Royal College in Surgeons in Ireland, Dublin, IRL (JMU).
MD, MPH, FAAFP
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Jane M. Uygur
From University of Washington, Seattle, WA. USA (WRP, TRE), Royal College in Surgeons in Ireland, Dublin, IRL (JMU).
MD, CCFP, MClSc
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Thomas R. Egnew
From University of Washington, Seattle, WA. USA (WRP, TRE), Royal College in Surgeons in Ireland, Dublin, IRL (JMU).
MA, EdD
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Abstract

Suffering is often a part of the illness experience, and relieving it is a fundamental obligation of medicine. Distress, injury, disease, and loss generate suffering when they threaten meaning in the patient’s personal narrative. Family physicians have exceptional opportunities and responsibilities to manage suffering through long-term continuity relationships, demonstrating empathy, and building trust over time and across problems. We propose a new Comprehensive Clinical Model of Suffering (CCMS) founded on the family medicine approach to whole-patient care. Comprehending that suffering can involve every aspect of a patient’s life, the CCMS is constructed on 4 axes and 8 domains that form a “Review of Suffering” to help clinicians recognize and manage patient suffering. Applied to clinical care, the CCMS can guide observation and empathetic questioning. Applied to teaching, it can provide a framework for discussions of complex and challenging patients. Barriers to applying the CCMS in practice include clinician training, time with patients, and competing demands. However, by structuring the clinical assessment of suffering, the CCMS may increase the efficiency and effectiveness of clinical encounters and improve patient care and outcomes. The application of the CCMS to patient care, clinical training, and research will require further evaluation.

  • Behavioral Medicine
  • Disease Management
  • Chronic Disease
  • Clinical Medicine
  • Communication
  • Comprehensive Health Care
  • Continuity of Patient Care
  • Empathy
  • End of Life Care
  • Family Medicine
  • Medical Ethics
  • Palliative Care
  • Patient-Centered Care
  • Primary Health Care
  • Suffering
  • Quality of Life
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The Journal of the American Board of Family     Medicine: 37 (6)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 6
November-December 2024
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A Comprehensive Clinical Model of Suffering
William R. Phillips, Jane M. Uygur, Thomas R. Egnew
The Journal of the American Board of Family Medicine Feb 2023, jabfm.2022.220308R1; DOI: 10.3122/jabfm.2022.220308R1

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A Comprehensive Clinical Model of Suffering
William R. Phillips, Jane M. Uygur, Thomas R. Egnew
The Journal of the American Board of Family Medicine Feb 2023, jabfm.2022.220308R1; DOI: 10.3122/jabfm.2022.220308R1
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  • Article
    • Abstract
    • Introduction
    • Understanding Suffering
    • Suffering and the Promise of Family Medicine
    • Developing a Model of Patient Suffering
    • The Comprehensive Clinical Model of Suffering
    • The Model at Work
    • Patient Care Example
    • Challenges and Barriers to Clinical Application of the Model
    • Limitations
    • Next Steps
    • Closing Comment
    • Acknowledgments
    • Appendix 1. Patient Care Example of Using the Comprehensive Clinical Model of Suffering
    • Appendix 2. Example Clinical Questions to Explore Domains of Patient suffering
    • Notes
    • References
  • Figures & Data
  • References
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Keywords

  • Behavioral Medicine
  • Disease Management
  • Chronic Disease
  • Clinical Medicine
  • Communication
  • Comprehensive Health Care
  • Continuity of Patient Care
  • Empathy
  • End of Life Care
  • Family Medicine
  • Medical Ethics
  • Palliative Care
  • Patient-Centered Care
  • Primary Health Care
  • Suffering
  • Quality of Life

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