The system runs smoothly when patients don't ask questions.
Not because doctors are hiding something — most aren't. But because the machine is built for compliance, not inquiry. Appointments are short. Protocols are standardized. The path of least resistance is to nod, sign, and schedule the next visit.
Questions create friction. They slow things down. They force explanations that reveal assumptions. They expose the difference between "this is what we do" and "this is what the evidence shows."
These are the questions that matter. Some will get clear answers. Some will get deflection. The deflection tells you something too.
About Your Treatment
"What is the evidence that I should continue treatment rather than stop?"
Not "is there evidence I should stop" — flip it. The burden should be on continuation, not cessation.
"What clinical trials inform this recommendation, and what treatment duration did they actually study?"
Most immunotherapy trials studied 2 years. If you're at year 4, ask why.
"What are the defined stopping criteria for someone with my response?"
If there are none, ask why not. "Until progression" isn't a plan — it's an absence of one.
"What is the minimum effective treatment for my situation?"
Not the maximum tolerated. Not the standard protocol. The minimum that achieves the outcome.
"What would you recommend if this were your body? Your spouse? Your parent?"
Doctors make different choices for their families than they recommend to patients. This question surfaces that gap.
"What happens to patients like me who choose to stop treatment and monitor?"
Someone has done it. What were their outcomes? If the doctor doesn't know, that's information too.
"What are the risks of continuing treatment, not just the risks of stopping?"
Every intervention has risks. Make them name them with the same specificity they use for the risks of not treating.
"Is this recommendation based on evidence for my specific situation, or is it the standard protocol applied broadly?"
Standard of care is a floor, not a ceiling. It may not be optimized for you.
About the Evidence
"Can you point me to studies showing this doesn't work — not just absence of evidence, but actual negative evidence?"
"Not evidence-based" often means "I haven't read about it." There's a difference between disproven and unstudied.
"Who funded the studies you're basing this on?"
Drug companies fund most clinical trials. That doesn't make them wrong, but it shapes what questions get asked.
"What questions did those studies not answer?"
Every study has limitations. Understanding what wasn't measured matters as much as what was.
"How recent is the evidence? Has anything changed in the past few years?"
Medicine moves slowly. The protocol you're on may be based on studies from a decade ago.
"Are there studies showing better outcomes with a different approach?"
The recommendation you're getting may not be the only option with evidence behind it.
About Alternatives
"What are all my options — not just the one you're recommending?"
Don't accept a binary choice between their recommendation and nothing.
"What would a different specialist recommend for this?"
Surgeons recommend surgery. Oncologists recommend chemo. Radiation oncologists recommend radiation. Each sees through their own lens.
"What do patients who declined this intervention experience?"
Someone has said no. What happened to them?
"Is there a less aggressive approach with similar outcomes?"
More is not always better. Sometimes less achieves the same result with fewer costs.
"What lifestyle or nutritional interventions have evidence for my condition?"
These rarely get mentioned because they're not billable. That doesn't mean they don't work.
"What would watchful waiting look like, and what would trigger intervention?"
Doing nothing isn't passive. Active surveillance with clear criteria is a legitimate strategy.
About the Money
"Can I see an itemized bill for this visit/procedure before I agree to it?"
You have the right to know what you're being charged for. Most people never ask.
"What is the cash price for this versus the insurance price?"
The chargemaster price is fiction. Cash prices are often dramatically lower.
"Is there a generic or less expensive alternative that's equally effective?"
Brand loyalty in pharmaceuticals is marketing, not medicine.
"Does your practice profit from this test, procedure, or infusion?"
Buy-and-bill creates incentives. In-house labs and imaging create incentives. It's not wrong to ask.
"Would you recommend the same thing if I were paying out of pocket?"
"Your insurance covers it" removes a natural check on value. Put it back.
"Who else is billing me for this visit?"
Facility fees, separate physician bills, lab fees, anesthesia — the bills multiply. Know who's charging what.
About Duration and Stopping
"How will we know when it's time to stop?"
If there's no answer, you're on an indefinite protocol with no exit criteria.
"What does the research say about outcomes for patients who stopped at this point versus those who continued?"
This data may not exist. That absence is the problem.
"Has anyone studied the minimum effective duration for this treatment?"
Probably not. Ask why not.
"If I wanted to stop and monitor, what surveillance protocol would you recommend?"
A good doctor will partner with you on this. A defensive one will resist.
"What would have to be true for you to recommend stopping?"
Make them define the criteria. If they can't, there are no criteria.
About Tests and Procedures
"What will this test tell us that will change what we do?"
If the answer is "nothing" or "we'll repeat it in six months either way," question why you're doing it.
"What are the false positive and false negative rates?"
Tests aren't perfect. A positive result may not mean what you think.
"What happens if we find something incidental?"
Incidental findings create cascades. Know what you're signing up for.
"Is this test for my benefit or for liability protection?"
Defensive medicine is real. Sometimes the test is for their peace of mind, not yours.
"What's the radiation exposure, and is it necessary?"
CT scans add up. Not all imaging requires radiation.
"Can we wait and see if symptoms resolve before testing?"
The body heals. Not every symptom requires immediate workup.
About Second Opinions
"I'd like a second opinion. Can you recommend someone outside your practice/system?"
Inside the same system, you'll often get the same answer. Go outside.
"Will you send my records to the physician of my choice?"
You have the right to your records. Don't let friction stop you.
"Is there an academic center or NCI-designated cancer center I should consult?"
Academic physicians may have different perspectives than community oncologists.
"Are there clinical trials I should consider?"
Trials offer access to new treatments and closer monitoring. Your doctor may not mention them.
About Documentation
"What are you writing in my chart about this conversation?"
You have the right to know how your decisions are being documented.
"Please document the questions I've asked and your responses."
If they're going to note that you declined something, make sure your reasoning is there too.
"Can I get a copy of my records from today's visit?"
Review what's being written. Errors happen. Framing matters.
When You're Not Getting Answers
"Why are you reluctant to answer this question?"
Sometimes the deflection is the answer.
"If you don't have this information, who does?"
Push for a referral to someone who can address your question.
"I need to understand this before I move forward. Can we schedule a longer appointment?"
Fifteen minutes isn't enough for complex decisions. Demand the time.
"What would happen if I waited a month before deciding?"
Most things aren't emergencies. Time pressure often serves the system, not you.
The Meta-Question
Before any major decision, ask yourself:
"Who benefits if I say yes? Who benefits if I say no?"
If saying yes benefits everyone except you — the drug company, the hospital, the practice, the doctor's liability protection — that doesn't mean it's wrong. But it means you should look harder at the evidence.
Your interests and the system's interests are not always aligned. These questions help you find out when they diverge.
How to Use These Questions
Record your appointments.
You don't hear everything when you're scared. You're processing a cancer diagnosis, or scan results, or treatment options — and your brain is in survival mode, not note-taking mode.
Record the conversation. Most smartphones have a voice memo app. Tell the doctor you're recording so you can review it later — most will agree without issue.
Then listen again when you're not in the chair. Have a loved one listen. You'll hear things differently. You'll catch things you missed. You'll notice what was actually said versus what you thought you heard.
When you're in fear and feel alone, you don't retain information the way you think you do. The recording is your backup brain.
Bring someone with you.
A second set of ears catches what you miss. They can take notes while you focus on the conversation. They can ask the questions you forget in the moment.
Bring a notepad.
Write down the names of studies, drugs, tests — anything specific they mention. Don't rely on memory. Don't rely on them to send it later.
Ask for studies and sources in writing — and follow up.
When a doctor cites a study or evidence, ask for the nurse to email it to you. Get the name, the journal, the year — something you can search yourself.
Fair warning: they'll say they will. In my experience, they never did — or they forgot. So write it down yourself, and look it up on your own. Don't wait for an email that may never come.
Pick the questions that apply to your situation.
Print them out. Bring them to appointments.
Notice what gets answered clearly and what gets deflected.
A straight answer is a good sign. Irritation, dismissal, or deferral tells you something too.
Don't apologize for asking.
You're not being difficult. You're being responsible for your own body.
Get it in writing when it matters.
Verbal assurances disappear. Documentation doesn't.
The system is built for patients who don't ask questions. Be the patient who does.
Next Up
How Medicine Makes Money
Understand the financial incentives behind every recommendation you receive.