A Comprehensive Clinical Model of Suffering

Suffering is often a part of the illness experience, and relieving it is a fundamental obligation of medicine. Distress, injury, disease, and loss generate suffering when they threaten meaning in the patient's personal narrative. Family physicians have exceptional opportunities and responsibilities to manage suffering through long-term continuity relationships, demonstrating empathy, and building trust over time and across problems. We propose a new Comprehensive Clinical Model of Suffering (CCMS) founded on the family medicine approach to whole-patient care. Comprehending that suffering can involve every aspect of a patient's life, the CCMS is constructed on 4 axes and 8 domains that form a "Review of Suffering" to help clinicians recognize and manage patient suffering. Applied to clinical care, the CCMS can guide observation and empathetic questioning. Applied to teaching, it can provide a framework for discussions of complex and challenging patients. Barriers to applying the CCMS in practice include clinician training, time with patients, and competing demands. However, by structuring the clinical assessment of suffering, the CCMS may increase the efficiency and effectiveness of clinical encounters and improve patient care and outcomes. The application of the CCMS to patient care, clinical training, and research will require further evaluation.