Why you get better care when you stop nodding and start asking why

Published 3 August 2026 · health

Priya walks into an orthopedician’s clinic with knee pain that she says she has had for three months. The doctor spends eight minutes with her

Priya walks into an orthopedician’s clinic with knee pain that she says she has had for three months. The doctor spends eight minutes with her, orders an MRI, and asks her to come back with the images. MRI shows signs of early osteoarthritis. The doctor lists three options: injections, physiotherapy or wait and watch. Priya nods, does not ask why she needed an MRI when the doctor could have examined her knee, and does not ask what ‘early osteoarthritis’ actually means or what happens if she does nothing. She opts for injections because of how she thought the doctor said it — some inflection and tone. Six months and four injections later, she has spent ₹15,000 but her pain is back. She is wondering if she got scammed, and if injections were ever the right call. Priya was probably not scammed — but she made a decision about her body without understanding it. She did not know that she could have asked questions and she did not know that the doctor was not sure either. Medicine is not certainty You are taught that doctors discover diagnoses, that there is always a right answer, and that diagnoses are always objective. They are not. When the orthopaedician looked at Priya’s knee, he was thinking that the probability of osteoarthritis was 40%, a meniscal tear 30%, a muscle strain 20% and in fact a 10% chance it was something else. He did not know for certain; his estimates were based on knowledge and experience, and probably what his last 10 patients had. The MRI showed signs of arthritis — but arthritis on imaging does not always mean it is also the cause of pain. Plenty of people have degenerative changes and feel nothing while an equal number have almost no changes and have terrible pain.

Instead, the orthopaedician interpreted the image, made an educated guess, and advised treatment. Another doctor might have looked at the same image and said, “Wait. Let us see if physiotherapy helps first.” A third doctor might have said, “This is asymptomatic degeneration. Leave it alone.” None of them would be objectively wrong. They are all interpreting the same evidence differently based on their experience, training, risk tolerance, and — honestly — how busy their practice is and what procedures they are equipped to do. This is clinical medicine. It is not a process of discovery. It is almost always going to be a series of educated guesses filtered through a doctor’s particular worldview. And once you understand this, you realise something: if there is no objective right answer, you need to have a say in the decision. Your life is not the doctor’s life. Your pain tolerance is not theirs. Your willingness to spend ₹15,000 on injections is not theirs. On different tracks Doctors are trained to approach illness in a particular way — whereas what you want out of treatment may be vastly different. When this is not discussed, a large mismatch in expectations can develop, resulting in a trust deficit and ultimately disappointment. Medical schools teach budding doctors to prevent disease, minimise risk, and, when in doubt, to investigate. This makes sense if you have seen someone die of a missed diagnosis. The goal becomes to not miss anything, ever. The orthopedician was thinking: arthritis found, need to prevent progression, imaging confirms it, treat aggressively. Priya was thinking: my knee hurts, what is the quickest solution? One of them is inevitably frustrated and dissatisfied. This happens every day in Indian hospitals. A doctor sees borderline blood pressure and recommends medication.