Risk & Reward: How to Reframe Your Medical Questions to Get What You Need
Why "Can I?" is the wrong question to ask your doctor
ICYMI 👉
Last week I asked you, dear readers, two questions: What health issues do you worry about the most? What do you need most from your doctor—and from the US medical system—that you’re not getting? The responses flooded in, and they fall into several clear categories:
Access and availability. Many of you can’t get timely appointments with your doctors. You’re waiting months to be seen, struggling to get callbacks about test results, and feeling abandoned when you need help most.
Lack of communication and coordination. You’re bouncing between specialists who don’t talk to each other, getting redundant tests, and receiving conflicting advice, with no one looking at the whole picture of your health.
Dismissal and disbelief. Your symptoms are being minimized, attributed to anxiety or “just menopause,” or met with responses like “your labs look fine” when you know something is wrong.
Information gaps. You’re not getting the full picture about treatment risks and benefits. Major medical decisions—from dosing to delivery mode—are being made without the nuanced conversations you deserve.
Turning to “Dr. Google” out of desperation. Without access to a trusted medical guide, you’re searching online for answers to basic health questions—and then getting blamed for it! (Of course you’re going to look online when your doctor doesn’t have time to explain things!) The problem isn’t that you’re searching; it’s that you don’t know who to trust, where to look for reliable information, and how to interpret what you find.
I can’t solve the systemic problems of the US medical system (today). But what I can do is help you become more empowered as a patient and consumer of healthcare. My goal is to give you the tools to navigate a broken system more effectively, to ask better questions, and to advocate for yourself when the system fails you.
So today I will tackle the MAJOR problem of lack of access to a medical provider to answer specific medical questions. One reader, Ken, captured this perfectly when he wrote me about what keeps him up at night:
“All the controversial ones… is fat good or bad? Are statins not worth the risk? Keto or Ornish? Should I be on metoprolol or listen to the recent study that says it’s way overprescribed? You get the idea.”
Ken, I do get the idea! And here’s the thing: these questions don’t have simple yes or no answers. They can’t be solved by Googling “are statins safe?” or scrolling through headlines. They require something our healthcare system is failing to provide—a conversation about risk, benefit, and YOU specifically.
I hear versions of these all the time from patients and readers:
“Can I take HRT in my 60s?”
“Is it safe to take melatonin for insomnia?”
“Can I work on improving my diet instead of taking a statin for heart health?”
These are excellent questions. But there’s a fundamental problem with how they’re framed: “Can I?” implies that there’s a simple yes or no answer, a one-size-fits-all rule that applies to everyone. It also implies that decisions like these require permission from your doctor, rather than educational information and a frame to understand tradeoffs inherent in it. It positions your doctor as a gatekeeper who grants or denies access, rather than as a partner who arms you with the tools to make individualized decisions.
My advice: stop asking your doctor for permission and start asking for a dialogue about risk, benefit, and YOU.
I realize not everyone has access to a medical provider who can engage in these kinds of discussions. I realize it’s unrealistic to expect everyone to get one. So allow me to help you reframe some of your questions in order to get what you need from our broken system—and to make sure you’re not settling for less by surfing the internet for quick answers.
Everything Carries Risk
Remember: everything we do carries risk. Every single thing.
When you drink alcohol, you’re accepting the known risks of weight gain, insomnia, breast cancer, and accidents in exchange for the pleasure or social connection it provides you. When you get in your car, you’re deciding that getting to your destination faster than walking there is worth the risk of a flat tire or an accident. We don’t think of these activities as “risky” because we do them so routinely. But make no mistake: every time you open a bottle of wine or turn the key in your ignition, you’re subconsciously engaging in risk-benefit analysis. Medical decisions include the same rubric.
Nothing is risk-free, so let’s stop pretending the risk-free, certainty-laden choice was ever on the menu!
Risk Isn’t Monolithic
Here’s the thing: risk is not a fixed number that applies equally to everyone. Risk is on a continuum. The degree of risk you face from any medication, intervention, or lifestyle choice hinges entirely on your underlying health conditions, age, genetics, family history, and dozens of other factors that make you uniquely you.
The same thing applies to benefits. The degree of benefit you might get from a prescription medication or medical intervention depends on your age, health issues, and symptoms.
Take hormone replacement therapy. The question I get from patients and newsletter readers, “Can I take HRT in my 60s?” is unanswerable without context. For one woman, HRT at age 65 might carry minimal risk and offer significant benefits for bone health, cardiovascular protection, and quality of life. For another 65-year-old woman—say, someone with a history of blood clots or hormone-sensitive breast cancer—that same therapy could pose more risks.
Each of them deserves a conversation about the Women’s Health Initiative data. Each deserves to know that the benefits of HRT tend to outweigh the risks when a woman starts HRT within 10 years of menopause. (I wrote an article about some of the considerations around HRT later in life here.) And then—and this is the crucial part—each of them should make a decision for themselves, based on a conversation about the data, their particular health issues and goals, and their tolerance for risk.
The same principle applies to every medical decision. Take Ken’s question about statins. I can’t tell him whether the risks are worth it to him without knowing his LDL level, family history, whether he has diabetes, whether he’s had a heart attack, what his coronary calcium score shows, what other medications he takes, what changes in his diet and fitness routines he’s already made, the feasibility of further habit changes, and what his personal health goals are. The calculus is completely different based on context!
Even something as seemingly benign as melatonin requires individualization. For someone struggling with occasional jet lag, a low dose carries negligible risk. For someone taking multiple medications that interact with melatonin, or someone with an autoimmune condition, the risk-benefit ratio shifts.
The Questions You Should Be Asking
Medical care isn’t supposed to be about gatekeeping. It’s about education and partnership. Here’s what that looks like in practice:
Instead of asking “Can I take HRT?” try this: “Based on your knowledge of the medical data and my specific health situation, what are the potential benefits of HRT for me, and what are the potential risks for me?”
Instead of “Is it safe to take melatonin?” ask: “What are the known potential risks of melatonin for someone with my medical history, and what are the potential benefits? Are there interactions with my other medications I should know about?”
Instead of Ken’s question “Are statins not worth the risk?” (sorry to pick on you, Ken!), instead try: “What are the specific reasons my cholesterol levels need to be lower than they are? What’s my specific goal? What are the potential risks and benefits of a statin for me given my health situation? What are the risks of not taking a statin?”
These reframed questions shift the conversation from permission-seeking to information-gathering. They acknowledge the patient-doctor partnership, not that your doctor is unilaterally deciding what you’re “allowed” to do.
Why We Default to Yes/No Thinking
I understand why people want simple answers. I really do. I think there are two main reasons this happens:
First, too many people don’t have access to a doctor who can actually walk through these decisions with them. When you get 15 minutes with a hurried medical provider, there’s little time for nuanced discussion about risk stratification and personalized decision-making. It’s always faster to say “yes” or “no” than to explain the reasoning. This is a failure of our healthcare system, not of patients who are doing their best to navigate it. It’s also not the fault of doctors who don’t have time to establish rapport and spend time going through the nuances of decisions.
Second, we are drowning in health information—from podcasts, Instagram wellness influencers, friends who swear by this supplement or that diet, contradictory headlines about what causes cancer this week. When you’re overwhelmed, simple binary answers feel like a life raft. “Yes” or “no.” “Safe” or “dangerous.” “Do this, not that.” (Read my article on the pitfalls of the wellness industry here.)
But complex health problems can’t be solved with simple answers. They require data, critical thinking, and personalized recommendations. That’s the essence of good medical care (and it’s exactly what’s missing in American healthcare right now).
Being an empowered patient means understanding that uncertainty is inherent in medicine, and that the goal isn’t to eliminate risk but to understand and mitigate risk alongside someone you trust with your health.
The Upshot
As one half of the patient-doctor relationship, catch yourself when you ask a medical provider “Can I do X?” and, instead, start asking “What are the tradeoffs of doing X?” Start demanding the information you need to make decisions that align with your values and your life.
You don’t need permission to take charge of your health. You need information, partnership, and a trusted guide! That’s what it means to be an empowered patient.
🙋🏻♀️ Does this resonate? What questions do you have? I am all ears! Drop your comment below.
Disclaimer: The views expressed here are my own and are not a substitute for advice from your personal physician.
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Kind of ironically, when I ask chat GPT these questions framed as yes/no, it reframes them as risk reward for me, but my doctor (gp) generalizes everything to the basic yes no without seeming to listen to my specific concerns.
Oh Dr. McBride, yes, yes! This post will resonate with everyone who reads it here, in their email, and for all to whom we share!
This is another print and post, to read for every prep before a doctor’s visit.
Thank you!