Priya walks into an orthopaedician’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.
The 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. Patient thinks: I feel fine, I do not need this. Both are right. Both are wrong. That is because they are having two separate conversations.
Crucially, the system does not teach doctors to fix this. As a patient, you can respond by asking questions.
How to be a good patient
To be a good patient:
First, demand clarity on usefulness. Ask“what will this tell us that changes my treatment?”, “what happens if it is normal?”, “what happens if it is abnormal?”, “how will you use this information?”, and “what are the guidelines to treat this?”.
Why? A doctor who can answer gets to keep your trust. But if the doctor dodges or gets irritated, you now know something important about how they practice.
Second, insist on options. Even osteoarthritis does not have just one treatment. The options include observation, physiotherapy, medications, injections, and surgery.
Why? A doctor operating in good faith might say, “We could try A, which works for some people but has risks, or B, which is safer but might not work. What matters more to you?”
Third, interrupt when you are confused. Do not nod and leave confused. Say “I did not follow that. Please explain it differently.”
Why? Doctors do not mind. They would rather know and try again than have you leave thinking you understood.
One important question
Before any major treatment, ask: “What would you do if this was your mother?”
The answer is often different from what the doctors are recommending for you. This does not mean they are being unethical; it often means something else. Maybe they do not know your full picture: your job, your life, your ability to cope with side effects. With their mother, they know all of it. Or maybe they are being more cautious with their mother not because it is better medicine but because emotion changes judgment. Or maybe they realise there are actually multiple valid approaches and they have been presenting one option like it is the easiest one.
Your doctor knows there are choices — and they may have recommended one for reasons they have not explained. So Priya could have asked, “If this was your mother’s knee, would you do four injections over six months?” The likely reply: “No. I would try physiotherapy first, and injections if that does not work.”
When you are still suffering
You followed the plan. You are compliant, you are taking your medicines, doing your exercises, and generally doing what you were told. Nothing is working. In these circumstances, you should have a different conversation, e.g.: “I am following your plan but not getting better. What does that mean?”
Do not think you are accusing the doctor; you are simply investigating. Maybe the diagnosis was wrong, you need to wait longer, you need surgery or something else. You and your doctor need to figure it out together.
Stop thinking your job is to obey. You know your body and yourself. The doctor knows medicine. Both of you are necessary to make a good decision. Making an informed choice is always better than a compliant one. It will also improve doctor-patient relations. As much as you deserve a good doctor, doctors also deserve good patients.
(Narayana Subramanian is Lead Consultant, Head and Neck Surgery and Oncology, Aster Hospitals, and Adjunct Faculty, Indian Institute of Science, Bengaluru.)
