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The goals of medicine and the nature of suffering

The relief of suffering has always been one of the main drives in those who pursue a career in health care. As pointed out by EJ Cassel in a cornerstone article published in 1982 on the New England Journal of Medicine:

Physicians’ failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.

During their Summer Shadowing Program in Rome, our fellows Catherine, Peter, and Michael had a chance to encounter and see first-hand what suffering means to patients and doctors. The Fellowship Program gave them a chance to do more than just discover Italian culture, immerse themselves in the beauty of a different country and learn some Italian: it was an occasion to delve into the reality of a physician’s life and discover the effect that pain and suffering have on their job. Here are some of their reflections, based on the analysis of the 1982 article written by EJ Cassel and their own observations of patients in the hospital wards and in outpatient settings.

Catherine Steffens ’20
Gettysburg College

“Many times physicians can forget that a treatment may resolve the medical issue of the patient, but if it gets in the way of the patient’s way of life, it is not the correct treatment. For example, a vocalist cannot take medication if some of the primary side effects are dry mouth and trouble taking deep breaths without suffering because the treatment impedes their livelihood. It is crucial as physicians to take into account the intersections of a patient’s life in order to give the best medical care. As developed in this article, a loss from what makes someone human can lead to suffering. The patient mentioned in the article had become depressed due to her suffering from the loss of her ability to sculpt as well as her physical features being altered, unable to have the confidence from before the treatment. Although it would have been much more difficult for the doctors to find a treatment that would have avoided these issues, the patient would have most likely suffered less. The phrase “quality of life” should always be in the heads of physicians for their patients; the definition of “quality of life” changing for each patient as each life is different. Being able to have conversations with patients about options for their treatment based on how the therapy will affect the patients’ lives is beneficial for the patients and helps them feel in control of their own lives. Doctors do have the responsibility of caring for the health and wellness of others, but what is often left out from this care is the presence of suffering from the loss of what makes a patient’s life whole. By incorporating all dimensions and intersections of the patient’s life, this will aid in the overall “quality of life” for a recovering patient”.

Peter Stubin ’19
University of Maryland

“People can suffer in unexpected ways. For example, one can suffer tremendously during the sickness of a loved one. There is no medical condition that can be diagnosed to relieve that person’s suffering. People may also go through extreme happiness when their experience is expected to be painful. For example, women giving birth will describe the experience afterwards as painful but rewarding. Pain is not necessarily suffering.

However, the article failed to give doctors clear guidance on how to mitigate suffering during their patients’ treatment, especially when many facets of a person’s unconscious world are “unknown.” Doctors already have the challenging task of trying to keep patients alive. How can they be expected to control things that the patient cannot even describe in words when it is already challenging enough to control physical variables within the patient’s body that are known? For example, “ for the same word, a person may simultaneously have a cognitive meaning, an affective or emotional meaning, a bodily meaning, and a transcendent or spiritual meaning. And there may be contradictions in the different levels of meaning.” Even with the best intentions and a conscientiousness of avoiding patient suffering, a doctor is not guaranteed to relieve suffering.

Perhaps a few aspects of patient suffering are clear. For example, “when illness restricts the range of activity of persons, they are not themselves.” If a patient cannot perform the tasks and roles they used to do, they will suffer. However, it is not under the doctor’s control. If a patient will no longer be able to walk, the doctor cannot say that the patient can go back to marathon training. I believe that doctors can be trained to alleviate suffering they may cause through their communication by practicing compassion with their patients and figuring out what makes some patients more resilient than others so that they can facilitate resilience in the patients that are suffering the most.”

Michael Carinha ’20
Ithaca College

“Pain is much more than suffering from a physical source like a chemotherapy treatment or pain
post-operation, which is why a patient must be treated as a whole. Suffering can be physical,
mental, and spiritual where those not directly affected by the pain can still suffer. A parent of a patient can suffer tremendously, which can then, in turn, make the patient suffer more because they know that their pain is hurting others. Suffering can also occur from things besides physical pain like if they know that if a bad consequence or severe pain is coming, but not currently present.

People are very complex, and have multiple ways of identifying whether it be a group identity, personal identity, a relationship with friends and family, or a social role in their lives and suffering can affect anyone of these aspects of the person. Not being able to fulfill the role of being a mom when sick and be able to take care of their children is just one example of the suffering an illness can cause a patient. Again, this is why the patient must be treated as a whole person when being treated so that it may be possible to avoid any type of suffering. A person’s cultural background can also shape the perception of pain, like being super masculine affects people so that they may not feel like they’re suffering from something because their cultural identity alters their perception. The treatment itself can also affect suffering. If a female is taking medication that destroys her hair, breasts, and femininity, she’ll most likely experience more suffering due to a loss of identity. A person’s perception of what’s causing the pain determines the amount of suffering. For example, if a patient thinks they have some kind of shoulder tendonitis, they use a small dose of a pain killer. When they find out it’s a malignant disease, they use a larger dose to cope with the pain. It’s very clear that pain and suffering have multiple layers and can affect many different things, which is why people must be treated as a whole when they become patients; humans are extremely complex creatures and must be treated with careful consideration of every aspect of their being.”