Nature of Suffering and the Goals of Medicine » (2nd Edition)

Eric J. Cassell is Clinical Professor of Public Health at Cornell University Medical College, and an attending physician at The New York Hospital. He is a fellow of the Hastings Center and a member of the Institute of Medicine of The National Academy of Sciences. He is the author of The Healer's Art, The Place of Humanities in Medicine, and Talking with Patients.

The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick person: bodies do not suffer, people do. An exclusive concern with scientific knowledge of the body and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient.
The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years.

Doody Review Services

Reviewer:Patricia Wong, MD(Stanford University Medical Center)
Description:Eric Cassell presents a perceptive, insightful discussion on what it means to be ill from a humanity viewpoint. This book should be on the required reading list in psychiatry for medical students. You will discover why your patient will continue to be unwell even though you have made the proper diagnosis and instituted the proper treatment course and the laboratory studies have improved. Learn how to treat the soul and mind, not only the body. Unfortunately, this is not taught in medical school or is taught poorly. Experienced physicians would benefit from reading this book. It explains the difference between being a technician and a really fine doctor.
Purpose:The author's purpose is to educate physicians on alleviating patient suffering through the patient-doctor relationship. The ethical dilemmas physicians are faced with are explored in a soul searching manner. How do you decide to treat a patient when you feel it is "a waste of resources" and "wouldn't make a difference anyway" (i.e,. the patient is going to die irrespective of what will be done). How do you handle and feel about patients refusing your therapy when you are certain they may die if they don't follow your advice? Cassell points out that as technology advances in the medical arena, our ability to treat these kinds of problems is rapidly dwindling.
Audience:The audience is all medical care providers and students.
Features:The doctor-patient relationship is explored, promoting an understanding of disease in the context of how one experiences personal loss and control, framing it in terms of the conflict between the self and the body. Trying to present the patient with choices on sickness, disability, and death that will lead to harmony is as difficult as it sounds. A therapist should accompany every book sold. The history of the evolution of our thinking that saving someone from death and prolonging survival are the most important goals of a caregiver is presented. In the 19th century people commonly died in their 30s or 60s, but when CPR was discovered and antibiotics were developed, a debate emerged whether it was better to let someone go to heaven or stay on earth. This is very interesting stuff. You have to read it!
Assessment:This is one of the best written books of this genre.

1. Ideas in Conflict