By “turning toward” a patientâ€™s suffering, physicians can better help their patients and find more meaning in their work, says University of Rochester Professor Ronald M. Epstein, M.D., a doctor and investigator in medical education, physician burnout and mindfulness.
Turning toward suffering means to, first, recognize it. It requires doctors to ask patients about their experience of suffering, with questions such as “what’s the worst part of this for you?”
When patients suffer, doctors tend to want to fix things, says Epstein, and if they cannot, many doctors then withdraw emotionally. Sometimes doctors feel helpless in the face of suffering, and in those situations their own discomfort can be a useful wake-up call. Turning attention toward suffering doesn’t often fit neatly within the hurried, fragmented, world of clinical care.
His new essay “A Piece of My Mind” appears in the Journal of the American Medical Association. The essay was co-authored by oncologist Anthony L. Back, of the University of Washington.
Epstein and Back conducted a literature review on how doctors address suffering. Despite the universality of suffering, they discovered few articles on it in the medical literature, and those that did exist were published in journals rarely read by practicing clinicians.
“Physicians can have a pivotal role in addressing suffering if they can expand how they work with patients,” the article stated. “Some people can do this instinctively but most physicians need training in how to respond to suffering — yet this kind of instruction is painfully lacking.”
The authors offer an example of how doctors can address suffering more effectively using a story of a patient who went years without a diagnosis, despite pain and disability. Surgery and medical treatments had failed to help. Only after her physicians became truly curious about her experience, listening to her, looking at her, and bearing witness, were they able to help the patient heal.
Epstein and Back offered two clinical approaches to suffering to complement the familiar “diagnosing and treating.” These are referred to as “turning toward” and “refocusing and reclaiming,” and the authors suggest that doctors should use these approaches on a regular basis.
Turning toward suffering requires physicians to ask patients about their experience of suffering with interest-driven questions. To refocus and reclaim involves helping patients reconnect with what’s important and meaningful in their lives. This is especially important when suffering and its underlying causes cannot be eliminated. Sometimes this requires physicians to be supportive of a patient’s efforts to become more whole.
In the case described, the patient separated from her spouse and re-established a professional identity. By making those changes she looked beyond her suffering and again viewed herself as a complete human being.
Asking physicians to engage as whole persons in order to address patients as whole persons “is a tall order,” Epstein and Back wrote, “yet, it strikes us as more feasible than ever because of evidence that programs promoting mindfulness, emotional intelligence, and self-regulation makes a difference.”