A patient wrote to me and asked when he should speak up and how to ask his doctor questions.

I’m not sure I have all the answers. I hope some of my physician colleagues will comment.

There is a fine and very fuzzy line between asking good questions and being a pain in the ass. And that line is drawn in different places by different doctors. It ranges from zero tolerance for questions (See Dr. Sung on the TV show “Monday Mornings,” who, when asked a question about a procedure he recommended, said, “Not do—dead.”) to the most open-minded, usually a primary care doc or psychiatrist. There are issues of time, urgency, the physician’s perception of the patient’s level of understanding, the complexity of the disease or operation, and many more.

I had no problem with patients who researched their symptoms online. However, I would hate it when a patient brought a portfolio with 100 pages of downloaded material for me to comment on. There is a lot of garbage on the Internet.

And speaking of online information, WebMD published a list of 18 questions that they suggest patients ask their doctors about proposed treatments. I can pretty much guarantee you that if you pull this list out, most doctors will not be too happy. Many of these questions should be part of any reasonable doctor’s explanation of informed consent or treatment before the subject of questions arises.

I think you should always ask what your options are. Informed consent discussions should include the risks, benefits, and alternatives for any procedure. The doctor should tell you what the risks and benefits of the alternatives are too.

Go with your gut. If what the doctor says to do does not sound right, say you will think it over. Don’t be afraid to get a second opinion. Run away quickly from any doctor who discourages second opinions. I always encouraged second opinions for patients who were reluctant to have surgery I recommended. I felt that if I was proposing the right thing, the second opinion doctor would support me.

One of the worst things a patient can do is to be too acquiescent to the physician. I used to tell patients, “Don’t worry about hurting your doctor’s feelings. This is your life we are talking about. The doctor will get over it. If she doesn’t, you don’t want her as a doctor anyway.”

What questions have crossed your line?

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 800 page views per day, and he has over 4900 followers on Twitter.