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

References

  1. 1.↵
    1. Callahan D
    . Managed care and the goals of medicine. J Am Geriatr Soc 1998;46:385–8.
    OpenUrlPubMed
  2. 2.↵
    1. Cassell EJ
    . The importance of understanding suffering for clinical ethics. J Clin Ethics 1991;2:81–2.
    OpenUrlPubMed
  3. 3.↵
    1. Cassell EJ
    . The Nature of Suffering and the Goals of Medicine. New York, NY: Oxford University Press; 1991.
  4. 4.↵
    1. Wilkinson I
    . Suffering: A Sociological Introduction. Cambridge, UK: Polity Press; 2005.
  5. 5.↵
    1. Svaneus F
    . The phenomenology of suffering in medicine and bioethics. Theo Med Bioeth 2014;35:407–20.
    OpenUrl
  6. 6.↵
    1. Cassel EJ
    . The nature of suffering and the goals of medicine. N Engl J Med 1982;306:639–45.
    OpenUrlCrossRefPubMedWeb of Science
  7. 7.↵
    1. Cassell EJ
    . The Nature of Healing. New York, NY: Oxford University Press; 2013.
  8. 8.↵
    1. Gadow G
    . Suffering and interpersonal meaning. J Clin Ethics 1991;2:103–7.
    OpenUrlPubMed
  9. 9.↵
    1. van Hooft S
    . Suffering and the goals of medicine. Med Health Care Philos 1998;1:125–31.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Edwards SD
    . Three concepts of suffering. Med Health Care Philos 2003;6:59–66.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Bishop JP
    . The Anticipatory Corpse: Medicine, Power, and the Care of the Dying. South Bend, IN: University of Notre Dame Press; 2011.
  12. 12.↵
    1. Bueno-Gómez N
    . Conceptualizing suffering and pain. Philos Ethics Humanit Med 2017;12:7.
    OpenUrl
  13. 13.↵
    1. Tate T,
    2. Pearlman R
    . What we mean when we talk about suffering—and why Eric Cassell should not have the last word. Perspect Biol Med 2019;62:95–110.
    OpenUrl
  14. 14.↵
    1. Donnelly WJ
    . Taking suffering seriously: a new role for the medical case history. Acad Med 1996;71:730–7.
    OpenUrlCrossRefPubMedWeb of Science
  15. 15.↵
    1. Cassell EJ
    . The nature of suffering. Presented at: Grand Rounds at Dunedin School of Medicine; July 27, 1998; University of Otago, Dunedin, NZ.
  16. 16.↵
    1. Epstein RM,
    2. Back AL
    . Responding to suffering. JAMA 2015;314:2623–4.
    OpenUrlPubMed
  17. 17.↵
    1. Egnew TR
    . Suffering, meaning, and healing: challenges of contemporary medicine. Ann Fam Med 2009;7:170–5.
    OpenUrlAbstract/FREE Full Text
  18. 18.↵
    1. Kellehear A
    . On dying and human suffering. Palliat Med 2009;23:388–97.
    OpenUrlCrossRefPubMed
  19. 19.↵
    1. Lee TH
    . The word that shall not be spoken. N Engl J Med 2013;369:1777–9.
    OpenUrlCrossRefPubMed
  20. 20.↵
    1. Egnew TR,
    2. Lewis PR,
    3. Schaad DC,
    4. Karrupiah S,
    5. Mitchell S
    . Medical student perceptions of medical school education about suffering: a multicenter pilot study. Fam Med 2014;46:39–44.
    OpenUrl
  21. 21.↵
    1. Back AL,
    2. Rushton CH,
    3. Kaszniak AW,
    4. Halifax JS
    . “Why are we doing this?”: clinician helplessness in the face of suffering. J Palliat Med 2015;18:26–30.
    OpenUrlCrossRefPubMed
  22. 22.↵
    1. Charon R
    . To see the suffering. Acad Med 2017;92:1668–70.
    OpenUrlPubMed
  23. 23.↵
    1. Egnew TR,
    2. Lewis PR,
    3. Myers KR,
    4. Phillips WR
    . Medical student perceptions of their education about suffering. Fam Med 2017;49:423–9.
    OpenUrl
  24. 24.↵
    1. Wise M,
    2. Marchand LR,
    3. Roberts LJ,
    4. Chih M-Y
    . Suffering in advanced cancer: a randomized control trial of a narrative intervention. J Palliat Med 2018;21:200–7.
    OpenUrlPubMed
  25. 25.↵
    1. del Giglio A
    . Suffering-based medicine: practicing scientific medicine with a humanistic approach. Med Health Care Philos 2020;23:215–9.
    OpenUrl
  26. 26.↵
    1. Tate T
    . What we talk about when we talk about pediatric suffering. Theor Med Bioeth 2020;41:143–63.
    OpenUrl
  27. 27.↵
    1. Daneault S,
    2. Lussier V,
    3. Mongeau S,
    4. et al
    . Primum non nocere: could the health care system contribute to suffering? Can Fam Physician 2006;52:1574–5.
    OpenUrlAbstract/FREE Full Text
  28. 28.↵
    1. Gawande A
    . Being Mortal: Medicine and What Matters in the End. New York, NY: Metropolitan Books; 2014.
  29. 29.↵
    1. Cherny NI,
    2. Coyle N,
    3. Foley KM
    . Suffering in the advanced cancer patient: a definition and taxonomy. J Palliat Care 1994;10:57–70. 1994.
    OpenUrlPubMed
  30. 30.↵
    1. Ferrell BR
    1. Kahn DL,
    2. Steeves RH
    . An understanding of suffering grounded in clinical practice and research. In Ferrell BR ed. Suffering. Sudbury, MA: Jones and Bartlett Publishers; 1996:3–27.
  31. 31.↵
    1. Chapman CR,
    2. Gavrin J
    . Suffering: the contributions of persistent pain. Lancet 1999;353:2233–7. 1999.
    OpenUrlCrossRefPubMedWeb of Science
  32. 32.↵
    1. Reed FC
    . Suffering and Illness: Insights for Caregivers. Philadelphia, PA: F. A. Davis Company; 2003.
  33. 33.↵
    1. Mount BM,
    2. Boston PH,
    3. Cohen SR
    . Healing connections: on moving from suffering to a sense of well-being. J Pain Symptom Manage 2007;33:372–88. 2007.
    OpenUrlCrossRefPubMedWeb of Science
  34. 34.↵
    1. Siler S,
    2. Borneman T,
    3. Ferrell B
    . Pain and suffering. Semin Oncol Nurs 2019;35:310–4.
    OpenUrl
  35. 35.↵
    1. Borrell-Carrió F,
    2. Suchman AL,
    3. Epstein RM
    . The biopsychosocial model 25 years later: principles, practices and scientific inquiry. Ann Fam Med 2004;2:576–82.
    OpenUrlAbstract/FREE Full Text
  36. 36.↵
    1. Amonoo HL,
    2. Harris JH,
    3. Murphy WS,
    4. Abrahm JL,
    5. Peteet JR
    . The physician’s role in responding to existential suffering: what does it mean to comfort always? J Palliat Care 2020;35:8–12.
    OpenUrl
  37. 37.↵
    1. Bartel M
    . What is spiritual? What is spiritual suffering? J Pastoral Care Counsel 2004;58:187–201.
    OpenUrlCrossRefPubMed
  38. 38.↵
    1. Kearsley JH
    . Therapeutic use of self and the relief of suffering. Cancer Forum 2010;34:98–101. Retrieved from https://search.informit.org/doi/10.3316/informit.186759252534959.
    OpenUrl
  39. 39.↵
    1. Dass R,
    2. Gorman P
    . How Can I help? New York, NY: Knopf; 1985.
  40. 40.↵
    1. Frankl VE
    . The Doctor and the Soul. New York, NY: Knopf; 1965.
  41. 41.↵
    1. Coulehan J
    . Compassionate solidarity: suffering, poetry, and medicine. Perspect Biol Med 2009;52:585–603.
    OpenUrl
  42. 42.↵
    1. Toombs SK
    . The metamorphosis: the nature of chronic illness and its challenge to medicine. J Med Hum 1993;14:223–30.
    OpenUrl
  43. 43.↵
    1. Farber SJ,
    2. Egnew TR,
    3. Herman-Bertsch JL,
    4. Taylor TR,
    5. Guldin GE
    . Issues in end-of-life care: patient, caregiver, and clinician perceptions. J Palliat Med 2003;6:19–31.
    OpenUrlCrossRefPubMed
  44. 44.↵
    1. Frankl VE
    . Man’s Search for Meaning: An Introduction to Logotherapy. Boston, MA: Beacon; 2006.
  45. 45.↵
    1. Romanucci-Ross L,
    2. Moerman D,
    3. Tancredi L
    1. Moerman DE
    . Physiology and symbols: the anthropological implications of the placebo effect. In Romanucci-Ross L, Moerman D, Tancredi L eds. The Anthropology of Medicine: From Culture to Method. South Hadley, MA: J. F. Bergin Publishers; 1983:156–67.
  46. 46.↵
    1. Toombs SK
    . The meaning of illness: a phenomenological approach to the patient-physician relationship. J Med Philos 1987;12:219–40.
    OpenUrlCrossRefPubMedWeb of Science
  47. 47.↵
    1. Cassell EJ
    . Recognizing suffering. Hastings Ctr Rep 1991;21:24–31.
    OpenUrl
  48. 48.↵
    1. Peterson ML
    . The Institute of Medicine report, “A manpower policy for primary health care”: a commentary from the American College of Physicians. Introduction and discussion. Ann Intern Med 1980;92:843–51.
    OpenUrlPubMedWeb of Science
  49. 49.↵
    1. Starfield B
    . Primary Care: Balancing Health Needs, Services and Technology. 2nd ed. New York, NY: Oxford University Press; 1998.
  50. 50.↵
    1. Loxterkamp D
    . Being there: on the place of the family physician. J Am Board Fam Pract 1991;4:354–60.
    OpenUrlFREE Full Text
  51. 51.↵
    1. Phillips WR,
    2. Haynes DG
    . The domain of family practice: scope, role, and function. Fam Med 2001;33:273–7.
    OpenUrlPubMedWeb of Science
  52. 52.↵
    1. Egnew TR
    . A narrative approach to healing chronic illness. Ann Fam Med 2018;16:160–5.
    OpenUrlAbstract/FREE Full Text
  53. 53.↵
    1. Nowak DA,
    2. Sheikhan NYU,
    3. Naidu SC,
    4. Kuluski K,
    5. Upshur REG
    . Why does continuity of care with family doctors matter? Review and qualitative synthesis of patient and physician perspectives. Can Fam Physician 2021;67:679–88.
    OpenUrlAbstract/FREE Full Text
  54. 54.↵
    1. Bendapudi NM,
    2. Berry LL,
    3. Frey KA,
    4. Parish JT,
    5. Rayburn WL
    . Patients’ perspectives on ideal physician behaviors. Mayo Clin Proc 2006;81:338–44.
    OpenUrlCrossRefPubMedWeb of Science
  55. 55.↵
    1. Benitez C,
    2. Howard KP,
    3. Cheavens JS
    . The effect of validation and invalidation on positive and negative affective experiences. J Posit Psychol 2022;17:46–58.
    OpenUrl
  56. 56.↵
    1. Tietbohl CK
    . Empathic validation in physician-patient communication: an approach to conveying empathy for problems with uncertain solutions. Qual Health Res 2022;32:413–25.
    OpenUrl
  57. 57.↵
    1. MacGaghie WC
    . Varieties of integrative scholarship. Acad Med 2015;90:294–302.
    OpenUrlCrossRefPubMed
  58. 58.↵
    1. Baron RJ
    . An introduction to medical phenomenology: I can’t hear you while I’m listening. Ann Intern Med 1985;103:606–11.
    OpenUrlCrossRefPubMedWeb of Science
  59. 59.↵
    1. Yager J
    . Addressing suffering in patients with psychiatric disorders. J Nerv Ment Dis 2021;209:615–21.
    OpenUrl
  60. 60.↵
    1. Balboni TA,
    2. VanderWeele TJ,
    3. Doan-Soares SD,
    4. et al
    . Spirituality in serious illness and health. JAMA 2022;328:184–97.
    OpenUrl
  61. 61.↵
    1. Casey LS,
    2. Reisner SL,
    3. Findling MG,
    4. et al
    . Discrimination in the United States: experiences of lesbian, gay, bisexual, transgender and queer Americans. Health Serv Res 2019;54:1454–66.
    OpenUrl
  62. 62.↵
    1. Stewart M,
    2. Brown JB,
    3. Weston WW,
    4. et al
    . Patient-Centered Medicine: Transforming the Clinical Method. Thousand Oaks, CA: Sage Publications; 1995.
  63. 63.↵
    1. Mauksch LB,
    2. Hillenburg L,
    3. Robins L
    . The establishing focus protocol: training for collaborative agenda setting and time management in the medical interview. Fam Sys Health 2001;19:147–57.
    OpenUrl
  64. 64.↵
    1. Wagner EH,
    2. Bennett SM,
    3. Austin BT,
    4. et al
    . Finding common ground: patient-centeredness and evidence-based chronic illness care. J Alt Compl Med 2005;11:s-7–15.
    OpenUrl
  65. 65.↵
    1. Stiggelbout AM,
    2. Van der Weijden T,
    3. De Wit MTP,
    4. et al
    . Shared decision making: really putting patients at the centre of healthcare. BMJ 2012;344:e256.
    OpenUrlAbstract/FREE Full Text
  66. 66.↵
    1. Mold JW
    . Goal-Oriented Medical Care: Helping Patients Achieve Their Personal Health Goals. Englewood Cliffs, NJ: Full Court Press; 2020.
  67. 67.↵
    1. Beach MC,
    2. Inui T
    , Relationship-Centered Care Research Network. Relationship-centered care: A constructive reframing. J Gen Intern Med 2006;21:S3–S8.
    OpenUrlCrossRefPubMed
  68. 68.↵
    1. Keeley R,
    2. Engel M,
    3. Reed A,
    4. Brody D,
    5. Burke BL
    . Toward an emerging role for motivational interviewing in primary care. Curr Psychiatry Rep 2018;20:41.
    OpenUrlCrossRefPubMed
  69. 69.↵
    1. Weng HY,
    2. Fox AS,
    3. Shackman AJ,
    4. et al
    . Compassion training alters altruism and neural responses to suffering. Psychol Sci 2013;24:1171–80.
    OpenUrlCrossRefPubMed
  70. 70.↵
    1. Rosenberg EL,
    2. Zanesco AP,
    3. King BG,
    4. et al
    . Intensive meditation training influences emotional responses to suffering. Emotion 2015;15:775–90.
    OpenUrl
  71. 71.↵
    1. Egnew TR,
    2. Lewis PR,
    3. Meyers KR,
    4. Phillips WR
    . The suffering medical students attribute to their undergraduate medical education. Fam Med 2018;50:296–9.
    OpenUrl
  72. 72.↵
    1. Dyrbye L,
    2. Shanafelt T
    . A narrative review on burnout experienced by medical students and residents. Med Educ 2016;50:132–49.
    OpenUrlCrossRefPubMed
  73. 73.↵
    1. Hansell MW,
    2. Ungerleider RM,
    3. Brooks CA,
    4. Knudson MP,
    5. Kirk JK,
    6. Ungerleider JD
    . Temporal trends in medical student burnout. Fam Med 2019;51:399–404.
    OpenUrlPubMed
  74. 74.↵
    1. Pellegrino ED
    . The commodification of medical and health care: the moral consequences of a paradigm shift from a professional to a market ethic. J Med Philos 1999;24:243–66.
    OpenUrlCrossRefPubMedWeb of Science
  75. 75.↵
    1. Rastegar DA
    . Health care becomes an industry. Ann Fam Med 2004;2:79–83.
    OpenUrlAbstract/FREE Full Text
  76. 76.↵
    1. Levinson W,
    2. Gorawara-Bhat R,
    3. Lamb J
    . A study of patient clues and physician responses in primary care and surgical settings. JAMA 2000;284:1021–7.
    OpenUrlCrossRefPubMedWeb of Science
  77. 77.↵
    1. Thomas L
    . The Youngest Science. New York, NY: Bantam Books; 1983.
  78. 78.↵
    1. Broyard A
    . Intoxicated by My Illness. New York, NY: Fawcett Columbine; 1992.
  79. 79.↵
    1. Toll E
    . The cost of technology. JAMA 2020;323:1661–2.
    OpenUrl
  80. 80.↵
    1. Anandarajah G,
    2. Hight E
    . Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician 2001;63:81–9.
    OpenUrlPubMedWeb of Science
  81. 81.↵
    1. Chochinov HM,
    2. Hassard T,
    3. McClement S,
    4. et al
    . The patient dignity inventory: a novel way of measuring dignity-related distress in palliative care. J Pain Symptom Manage 2008;36:559–71.
    OpenUrlCrossRefPubMedWeb of Science
  82. 82.↵
    1. Hubble MA,
    2. Duncan BL,
    3. Miller SC
    . The Heart & Soul of Change: What Works in Therapy. Washington, DC: American Psychological Association; 1999.
  83. 83.↵
    1. Batt-Rawden SA,
    2. Chisolm MS,
    3. Blair A,
    4. Flickinger TE
    . Teaching empathy to medical students. Acad Med 2013;88:1171–7.
    OpenUrlCrossRefPubMedWeb of Science
  84. 84.↵
    1. Cassell EJ
    . Diagnosing suffering. Ann Intern Med 1999;131:531–4.
    OpenUrlCrossRefPubMedWeb of Science
  85. 85.↵
    1. Farber SJ,
    2. Egnew TR,
    3. Herman-Bertsch JL
    . Issues in end-of-life care: family practice faculty perceptions. J Fam Pract 1999;49:525–30.
    OpenUrl
  86. 86.↵
    1. Egnew TR
    . The meaning of healing: transcending suffering. Ann Fam Med 2005;3:255–62.
    OpenUrlAbstract/FREE Full Text
  87. 87.↵
    1. Farber SJ,
    2. Egnew TR,
    3. Herman-Bertsch JL
    . Defining effective clinician roles in end-of-life care. J Fam Pract 2002;51:153–8.
    OpenUrlPubMedWeb of Science
  88. 88.↵
    1. Sedhom R,
    2. Sedhom D
    . To grow as a physician, try responding to suffering. J Palliat Care 2019;34:3–4.
    OpenUrl
  89. 89.↵
    1. Uygur J,
    2. Brown JB,
    3. Herbert C
    . Understanding compassion in family medicine: a qualitative study. Br J Gen Pract 2019;69:e208–e216.
    OpenUrlAbstract/FREE Full Text
  90. 90.↵
    1. Duke P,
    2. Frankel RM,
    3. Reis S
    . How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach. Teach Learn Med 2013;25:358–65.
    OpenUrlCrossRefPubMed
  91. 91.↵
    1. Gavinski K,
    2. Covin YN,
    3. Longo PJ
    . Learning to build illness scripts. Acad Med 2019;94:293.
    OpenUrl
  92. 92.↵
    1. Braveman P,
    2. Gottlieb L
    . The social determinants of health: it’s time to consider the causes of causes.Public Health Rep 2014;129:19–31.
    OpenUrlCrossRefPubMed
  93. 93.↵
    1. Hamed S,
    2. Bradby H,
    3. Ahlberg BM
    , Thapar-Bjökert. Racism in healthcare: a scoping review. BMC Pub Health 2022;22:988.
    OpenUrl
  94. 94.↵
    1. Trent M,
    2. Dooley DG,
    3. Dougé J
    et al. The impact of racism on child and adolescent health. Pediatrics 2019;144:e20191765.
    OpenUrlCrossRefPubMed
  95. 95.↵
    1. Krieger N
    . Discrimination and health inequities. Int J Health Serv 2014;44:643–710.
    OpenUrlCrossRefPubMed
  96. 96.↵
    1. Egnew TR
    . A philosophy for behavioral health integration in primary care. Fam Syst Health 2017;35:18–20.
    OpenUrl
  97. 97.↵
    1. Wallace E,
    2. Salisbury C,
    3. Guthrie B,
    4. Lewis C,
    5. Fahey T,
    6. Smith SM
    . Managing patients with multimorbidity in primary care. BMJ 2015;350:h176.
    OpenUrlFREE Full Text
  98. 98.↵
    1. Hubley S,
    2. Uebelacker L,
    3. Eaton C
    . Managing medically unexplained symptoms in primary care: a narrative review and treatment recommendations. Am J Lifestyle Med 2016;10:109–19.
    OpenUrlCrossRef
  99. 99.↵
    1. Mills S,
    2. Torrance N,
    3. Smith BH
    . Identification and management of chronic pain in primary care: a review. Curr Psychiatry Rep 2016;18:22.
    OpenUrlCrossRefPubMed
  100. 100.↵
    1. Volkow ND
    . Personalizing the treatment of substance abuse disorders. Am J Psychiatry 2020;177:113–6.
    OpenUrl
  101. 101.↵
    1. Rushforth A,
    2. Ladds E,
    3. Wieringa S,
    4. Taylor S,
    5. Husain L,
    6. Greenhalgh T
    . Long Covid–the illness narratives. Soc Sci Med 2021;286:114326.
    OpenUrlPubMed
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