Nav: Home

By asking, 'what's the worst part of this?' physicians can ease suffering

December 22, 2015

When patients suffer, doctors tend to want to fix things and if they cannot many doctors then withdraw emotionally. But by turning toward the suffering, physicians can better help their patients and find more meaning in their work, wrote University of Rochester Professor Ronald M. Epstein, M.D., in the Journal of the American Medical Association's weekly essay, "A Piece of My Mind."

As a national and international keynote speaker and investigator in medical education, physician burnout and mindfulness, Epstein is concerned about a lack of attention to suffering. It doesn't often fit neatly within the hurried, fragmented, world of clinical care, he said.

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 ubiquity of suffering, they discovered few articles in the medical literature--most of which 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 provide 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 were not enough. 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 use these approaches routinely.

Turning toward suffering means to, first, recognize it. It requires physicians to ask patients about their experience of suffering, through questions such as "what's the worst part of this for you?" Sometimes doctors feel helpless in the face of suffering, and in those situations their own discomfort can be a useful wake-up call.

To refocus and reclaim involves helping patients reconnect with what's important and meaningful in their lives, especially when suffering and its underlying causes cannot be eliminated. Sometimes that 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 saw past 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."

Epstein's published work is among the most widely cited in the scientific community; earlier this year four of his medical education articles were ranked by Academic Medicine as among the top cited in the last century. Back has also published numerous articles on patient-physician communication and palliative care.
-end-


University of Rochester Medical Center

Related Medical Education Articles:

Springer Healthcare launches Medicine Matters, a new medical education website
Springer Healthcare launches Medicine Matters, a new medical education website.
Researchers examine millennial generation's learning preferences in medical education
The classroom can reflect its students' learning preferences, and a study published today in Mayo Clinic Proceedings demonstrates evidence of this in medical education.
Travel restrictions 'a step backward' for US medical education, research and health care
The executive order restricting individuals from seven Muslim-majority countries from entering the US is 'a step backward,' for medical education, patient care and biomedical research in this country, write medical department leaders from Massachusetts General Hospital and six other major academic medical centers.
NYITCOM at A-State receives grant to establish a consortium for medical education
NYITCOM at A-State has received a grant from the Delta Regional Authority to support the establishment of the first Delta community-based clinical education consortium with medical and health institutions.
Chinese medical education rising unevenly from Cultural Revolution rubble
A new research review chronicling the history and current state of medical education in China finds that the country's quest to build up a medical education system to serve is massive population has produced a rapid, if uneven, result.
More Medical Education News and Medical Education Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Teaching For Better Humans
More than test scores or good grades — what do kids need to prepare them for the future? This hour, guest host Manoush Zomorodi and TED speakers explore how to help children grow into better humans, in and out of the classroom. Guests include educators Olympia Della Flora and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#535 Superior
Apologies for the delay getting this week's episode out! A technical glitch slowed us down, but all is once again well. This week, we look at the often troubling intertwining of science and race: its long history, its ability to persist even during periods of disrepute, and the current forms it takes as it resurfaces, leveraging the internet and nationalism to buoy itself. We speak with Angela Saini, independent journalist and author of the new book "Superior: The Return of Race Science", about where race science went and how it's coming back.