The Question Every Patient Should Ask Their Doctor

by Laurent Glatz – for Athletic Carnivore

A minor heart attack. A coronary angiography. A stent proposed without the patient being informed beforehand. This anecdote might seem marginal. It is not. It reveals a blind spot in contemporary medicine: informed consent has become more of a ritual phrase than a genuine process of education and shared decision-making.

In a talk titled “The Awkward Question Every Patient Should Ask Their Doctor,” Dr. Paul Mason revisits a series of troubling observations. His aim is not to discredit modern medicine. Rather, he questions how the real benefits of treatments are presented—and especially how these benefits are measured.

Informed consent is based on a simple principle: a patient can only accept a treatment if they understand its risks and benefits. In practice, risks are often mentioned, sometimes briefly, sometimes buried in legal jargon. Benefits, on the other hand, are presented as a given. Rare are the consultations where, supported by data, the actual impact of the treatment on survival is examined.

Yet the central question should be: will this treatment help me live longer or better?

Intermediate Markers: A Number Is Not Always a Benefit

To answer this question, one must first know which data to rely on. Contemporary medicine frequently uses “intermediate markers,” called surrogate markers. A drop in cholesterol. A decrease in blood pressure. An improvement in a biological parameter. These indicators are supposed to reflect a clinical benefit. But they are not, in themselves, proof of life extension.

The example of aspirin, extensively discussed by Dr. Mason, illustrates this gap. For decades, it was recommended for primary cardiovascular prevention. Then some major studies showed no significant benefit on overall mortality, while highlighting an increased risk of bleeding side effects. In secondary prevention, after a heart attack, the argument remains more nuanced. But when isolating randomized controlled trials evaluating all-cause mortality, the benefits appear more limited than commonly believed, sometimes restricted to very short periods.

Relative Risk, Absolute Risk: The Nuance That Changes Everything

The difference between relative risk and absolute risk adds a layer of complexity. Saying a treatment reduces risk by 50% may sound spectacular. But if the initial risk drops from 2% to 1%, the absolute reduction is only 1 percentage point. How statistics are presented strongly influences perception. Informed consent therefore requires a clear and understandable translation of the numbers.

Stents, Treatments, and Real Survival

The case of coronary stents raises similar questions. Randomized trials comparing stenting and optimal medical treatment in stable patients have not shown a significant reduction in overall mortality. Yet the practice remains widespread. Not because the procedure is useless in all situations, but because the precise indication, clinical context, and patient expectations are not always discussed with the methodological rigor that true dialogue demands.

The same logic applies to some recent lipid-lowering treatments, whose efficacy on biological parameters is demonstrated, but whose impact on overall mortality remains debated. The question is not to deny their potential usefulness. It is to clearly distinguish between improvement of a marker and prolongation of life.

The Simple Question That Puts Decision-Making Back at the Center

Dr. Mason proposes a deliberately simple, almost unsettling formulation. Faced with a therapeutic proposal, the patient could ask: can you provide me with the experimental study, ideally randomized and placebo-controlled, relevant to my profile, showing that this treatment reduces my all-cause mortality or improves my survival?

This request may feel uncomfortable. Yet it is legitimate. It does not question the practitioner’s competence. It reminds us that the role of the doctor, in the etymological sense, is also that of a teacher. To inform does not mean to impose. To expose uncertainty does not mean weakness. Scientific literature itself is often marked by gray areas, underrepresented populations, and contradictory results.

Acknowledging this uncertainty is a sign of medical maturity. In many cases, data are insufficient or incomplete for specific groups. Rather than hiding this reality, it should be shared. The patient then becomes a partner in the decision, not a mere executor.

Returning to the Real Goal of Treatment

This is not about encouraging systematic distrust. Modern medicine has transformed life expectancy and emergency care. But the accumulation of recommendations, protocols, and guidelines does not exempt critical reflection. A treatment can change a number without changing destiny. It can also improve quality of life without extending existence. These nuances matter.

The question every patient should ask is therefore not a provocation. It is an invitation to return to the essentials. What is the real goal of the treatment? What is the absolute probability of benefit? What is the absolute probability of risk? Do the data concern patients comparable to me?

In a healthcare system often rushed, where consultations are timed, this demand may seem unrealistic. Yet it lies at the heart of medical ethics. Informed consent is not a signed form. It is an honest conversation about what science knows, what it does not, and what the patient is willing to accept.

Medicine loses nothing by this transparency. It may gain what is most precious: enlightened trust.