The Nature of Suffering: BJ Miller and Naomi Saks

In 1982 Eric Cassell published his landmark essay: On the Nature of Suffering and the Goals of Medicine.  Though his narrow definition of suffering as injured or threatened personhood has been critiqued, the central concept was a motivating force for many of us to enter the fields of geriatrics and palliative care, Eric and I included.

Today we talk about suffering in the many forms we encounter in palliative care.  Our guests are BJ Miller, palliative care physician and c-founder of Mettle Health, and Naomi Saks, chaplain at UCSF. 

We discuss:

• How to respond when a nurse or trainee says, “I think this patient is suffering,” but the family does not share that perception

• The trap in comparing one person’s suffering to another person’s suffering

• How to respond to suffering, from naming to rebirth

• Ways in which suffering can bring meaning and purpose, or at the very least co-exist alongside growth and transformation

• The extent to which elimination of suffering ought to be a goal of palliative medicine (with a nod to Tolstoy)

• A simple 2 sentence spiritual assessment

Credit to my son Kai Smith on guitar on Everybody Hurts for those listening to audio only (hand still splinted at time of this recording)

-@AlexSmithMD

Additional links:

Screening for suffering: https://pubmed.ncbi.nlm.nih.gov/27714532/ and https://pubmed.ncbi.nlm.nih.gov/35195465/ and https://pubmed.ncbi.nlm.nih.gov/31387655/

Evans CB, Larimore LR, Grasmick VE. Hospital Chaplains, Spirituality, and Pain Management: A Qualitative Study. Pain Manag Nurs. 2023 Dec 20:S1524-9042(23)00202-3. doi: 10.1016/j.pmn.2023.11.004. Epub ahead of print. PMID: 38129210.

Kleinman, A. (2020). The illness narratives suffering, healing, and the human condition. 

Accepting This Poem by Mark Nepo https://marknepo.com/poems_accepting.php

Saks, N., Wallace, C.L., Donesky, D., & Millic, M. (in preparation). “Profession-specific Roles in Palliative Care.” In Donesky, D., Wallace, C.L., Saks, N., Milic, M. & Head, B. (eds.), Textbook on Interprofessional Palliative Care. Oxford University Press.