A common ending to a consultation where I have explained to a patient that there is nothing that surgery/medicine can reliably or safely offer them for their symptoms (back pain, joint pain, limited joint movement etc.) is “So I just have to live with it do I?” A difficult question to answer but also a question that tells us a lot about the person asking it.
In asking that question, the patient is forcing the doctor to treat them by painting the alternative (non-operative) option as being bleak. The patient is saying that it is not reasonable to expect them to continue in their current state – to ‘live with’ the symptoms.
But ‘living with it’ is exactly what they will have to do if there is no ready cure. And living with it can be a good thing. It can mean accepting one’s predicament and developing ways of adapting and coping. It can mean taking active personal responsibility rather than relying on others to deal with the problem – a problem that is often multifactorial and complex, and not restricted to a single identifiable anatomical abnormality.
Depending on the context, ‘living with it’ can also mean being a survivor rather than a victim, understanding one’s predicament relative to others, and focusing on what one can do rather than what one can’t do.
Reassurance and information can help people live with their conditions, much more than further futile attempts to address questionable diagnoses with even more questionable treatments.
‘Living with it’ can be a positive experience. There are many people in the world ‘living with’ all sorts of conditions involving pain and functional limitations, and they remain happy. Pain and suffering are two states that are more separate than most people think. Similarly, the correlation between disability and quality of life not clear.
Happiness is complex and often disconnected from one’s underlying physical condition. If you are unhappy because you have a sore back and can no longer sit for long periods or no longer play golf, you may actually be less happy than people who are physically worse off, and in more pain. In fact, the well-known and well-studied ‘disability paradox’ (here) notes that people with severe disabilities usually report good quality of life. They do not suffer, they thrive.
Acceptance of one’s current situation, acceptance of the fact that medicine may not be able to offer you a quick solution (or any solution at present) and learning to actually live with one’s condition, rather than using the phrase as sign of something undesirable is the first step in recovery. Not recovery from the condition but recovering one’s life and independence. Getting out of the dependency on medicine and taking responsibility for one’s condition and one’s happiness.
A better response than “do I have to live with it”, which I also hear occasionally is along the lines of: “as long as my condition is not progressive I think I will stop wasting my time and money on pursuing further treatments, adapt to my new state and start doing the things that I can, the things that make me happy”.
I am a surgeon with an interest in evidence based medicine: the science behind medicine. I am interested in finding the true risks and benefits of interventions, and how this often differs from the perceived risks and benefits, as seen by the public, the media, and the doctors themselves.
