key: cord-0013163-4h64j1oy
authors: Cooley, Laura
title: Microsuffering: Lessons From a Pinky Finger
date: 2020-09-30
journal: J Patient Exp
DOI: 10.1177/2374373520956398
sha: 307a7f626e9ed172111c5459ed90695bfcc322b8
doc_id: 13163
cord_uid: 4h64j1oy

nan

Following a minor injury to my pinky finger, I was recently enrolled in an uncomfortable education on microsuffering. Initially, I denied the severity of my injury: This is only a pinky. Stop whining! How disruptive can a tiny injury be?

In this editorial, I introduce the concept of microsuffering to account for the brief and commonplace ways that the healthcare system amplifies rather than alleviates distress. The term emerged through my personal lived experience and reflects the importance of understanding the medical story in the context of a person's social and emotional worlds.

After ignoring my swollen, immobile finger for 3 weeks, I finally resigned to the need for medical attention. First, I visited an urgent care center for an X-ray, still secretly hoping for a jammed finger diagnosis in need of a simple splint. Unfortunately, I departed with a referral to an orthopedic office for a fracture in my pinky finger joint.

I researched and booked my own appointment after a delayed referral: No big deal. I can just book an appointment myself and be back in the office by lunch time! First, the orthopedic office wanted to redo the X-ray: Uh-oh, is this worse than imaged? Do I need to pay for second X-ray?

Next, the surgeon was unavailable, so I needed to book another appointment in another location. Additionally, a computed tomography scan was recommended, at yet another location: Geez! How inconvenient! This must be worse than I thought! Surely, this will not require SUR-GERY, right?! Wrong. The surgeon surprised me with 2 options: (1) decline surgery and my finger will forever remain crooked, with low mobility and painful early-onset arthritis or (2) accept surgery and my finger may eventually be 95% normal. With great angst, I chose surgery: What?! Surgery, and general anesthesia, followed by 4 to 6þ weeks of therapy?! Is this necessary for one tiny finger?! I trudged out of the clinic feeling lonely, uncertain, and afraid. This was my first surgery and I have no family living in the vicinity: How painful will this be and for how long? Who would transport and care for me postsurgery? How would I manage my commitments? How much will this cost? How will I tell my mother, who will worry and be disappointed by my canceled visit? COVID-19 . . . (the list continued).

I reluctantly accepted help from friends and colleagues immediately postsurgery and canceled multiple work and personal engagements. I am grateful to be progressing toward recovery, though my struggles linger at times: Must I really wear this brace all day and night?! Is this therapy working? When can I type and resume more normal activities? Another 4þ weeks?! I remain hesitant to refer to my own insignificant experience with a label as significant as "suffering": Should I even acknowledge my minuscule finger when others are experiencing immense pain?

In his article The Word That Shall Not Be Spoken, Dr Thomas Lee (1) asserts that clinicians and editors of academic literature resist using the term "suffering" to describe the patient experience because the dire connotation discomforts them. After searching through medical resources, I confirmed his assertion; few researchers published literature that references suffering in the context of the patient experience prior to 2013 (note 1). A notable exception includes The Nature of Suffering and the Goals of Medicine, published in 1982, in which Dr Cassel (2) defines suffering "as the state of severe distress associated with events that threaten the intactness of the person." Embedded in this definition is a requirement that suffering be an extreme and critical experience.

Microsuffering invokes a less acute definition, which I propose as follows: a less grievous state of distress associated with experiences that cause inconvenience and perhaps pain (physical, emotional, and/or psychological) to an individual. Dr Cassel also acknowledged that "suffering can occur in relation to any aspect of the person," which makes suffering a subjective matter. The definition of microsuffering must leave space to validate the unique nuances of the individual lived experience.

We may also consider this concept within the framework offered by Mylod and Lee (3) who discuss the differences between unavoidable suffering and avoidable suffering. Unavoidable suffering occurs when an individual suffers from disease and sickness. This includes the pain associated with their treatment. Avoidable suffering involves the dysfunctions in healthcare delivery. Dysfunctions may include inconvenient delays for appointments and test results, receiving explanations from providers, and waiting on communication between caregivers.

I am inspired by increasingly prominent conversations on microaggressions, "defined as the everyday, subtle, intentional -and oftentimes unintentional -interactions or behaviors that communicate some sort of bias toward historically marginalized groups" [1] . Just we must heighten our awareness about the subtleties of racial injustice, we must also recognize the subtleties of microsuffering (which can easily be triggered by acts of microaggression). How might we address microsuffering? Brief moments in which we exercise the microskills of communication, empathy, and respect, contribute to feelings of trust and support -essential ingredients in a formula to reduce suffering (4) .

The latest issue of The Journal of Patient Experience (volume 7, issue 4) includes a Special Collection Section highlighting experiences of suffering during the COVID-19 pandemic and opportunities for virtual support via the telehealth context. Additionally, all authors of the current issue contribute meaningfully to our understanding of patient experience and suffering at large.

Editor-in-Chief, Journal of Patient Experience Note 1. Although researchers have dedicated more attention to the concept of suffering over the past decade, further research is required.

The word that shall not be spoken

The nature of suffering and the goals of medicine

A framework for reducing suffering in healthcare

Microaggressions Are A Big Deal: How To Talk Them Out And When To Walk Away