The Nature of Suffering: BJ Miller and Naomi Saks

GeriPal - A Geriatrics and Palliative Care Podcast

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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.

312 episode