Hola a tod@s, my dear friends.

I already wanted to share this gift that Enric Benito sent me a couple of months ago.

“Diagnosing Suffering: A Perspective” was published in Annals of Internal Medicine in 1999 by one of those persons who is just becoming a master: Eric J. Cassel.

Key points of the article:

It is crucial to relieve suffering.

Suffering cannot be treated unless it is recognized and diagnosed.

Its existence should be suspected in the presence of severe disease and we should directly ask patients about suffering.

Asking openly and active listening takes little time, and are encouraging.

Information on which is based the assessment of suffering, is subjective.

Knowledge of patients as individuals to understand the source of their suffering, and as a result, their best treatment, requires methods of empathic care and non-discursive thought which can be learned and taught. The relief of suffering depends on doctors to learn these skills.

When physicians attend bodies rather than people, fail to detect suffering.

In the care of a patient who suffes, attend the person means more than just caring for the patient or be compassionate.

Make a diagnosis means to ask if the patient is suffering and why. Although patients frequently do not know that they are suffering, they should be asked directly: “Are you suffering?” “I know that you have pain, but there is something that is even worse than the pain?” “Are you frightened by all this?” “What exactly are you afraid?” “Why are you worry? “Are you worry about your future?” “What is the worst thing about all this?”.

Once asked, patients must be given time to answer. These questions are open and vague on purpose; to suggest them they have permission to talk about things that usually no one before has asked and that is not expected any reply specifically. These questions are open expressly to imply that thay could talk about anything that worries them.

For people, the experience of disease is predominantly subjective. The relationship between the patient and physician, through which flows the medical attention and that is in itself indispensable for the discovery and relief of suffering, emerges and blooming in the field of subjectivity. If objectivity won, the relief of suffering would be a goal that medicine would be very far reaching.

One needs to hear what is said and what is not said, observe the face and body and his active expression, the non-verbal communication, smell him (his fear, hygiene or perfume), and learn to leave that this information flow without interpreting or judge and remain silent both inside and outside.

We must learn to be just open in the presence of the patient.

Learn these skills makes possible to diagnose and treat suffering even when the cause of the suffering can not cure or alleviate. To have an extraordinary experience to do so is not required. The main step is to start the way of approaching patients as people. The relief of suffering depends on it.

There it is.

Happy Friday,