Learning about social suffering through illness narrative: possibilities and challenges

Understanding social determinants of health is a crucial aspect of holistic healthcare, and cultivating empathy toward patients' suffering is increasingly recognized as a core competency for healthcare professionals. Although previous studies have examined the efficacy of narrative medicine-based education in enhancing empathic responses to patients, the possibility of learning concept of "social suffering" through patient illness narrative remains underexplored.

This study presents a qualitative analysis of short essays submitted by forty second-year medical students at a single medical school after a class based on narrative medicine principle. The students analyzed and interpreted a transcript of a patient with hypertension, revealing various dimensions of the illness experience, including anxiety regarding the disease, aversion to antihypertensive medications, and encounters with stigmatization and discrimination in the workplace. Using an iterative coding process with both inductive and deductive elements, we identified patterns in how students conceptualized suffering and engaged with social dimensions of illness.

Our analysis yielded three major themes: (1) categorical framings of suffering, (2) emerging recognition of narrative complexity, and (3) limited engagement with structural dimensions of social suffering. While students readily identified physical and psychological aspects of suffering, most demonstrated surface-level engagement with social dimensions. The students' responses revealed challenges in moving beyond individualistic frameworks to recognize how social, cultural, and institutional factors shape illness experiences in Korean society.

While the narrative medicine approach successfully fostered recognition of suffering's complexity and the importance of empathy, students' limited engagement with social suffering suggests the need for curricular enhancements. We propose a spiral curriculum that progressively deepens students' understanding of social determinants of health, integrates qualitative research methodologies, and explicitly addresses Korean sociocultural contexts that shape illness experiences. This approach may better equip future physicians to recognize and address social suffering in their clinical practice.