There is a silence I know well, because I was raised into it before I was ever a clinician.

A patient sits down, is told what is wrong and what must be done. The patient often says nothing, not because they have understood, but because they have quietly decided that understanding is not their place. To ask why would be to question; to question would be to disrespect.

Having practised in different settings around the world, I have come to understand that paternalism has its fingerprints all over healthcare. It is not a Nigerian thing. Western systems are richer, but not always wiser.

Paternalism is the old idea that the expert knows best and the patient’s job is to comply, an idea with deep and not entirely dishonourable roots. In cultures that respect age, learning and authority, deferring to the doctor can feel like good manners.

And clinicians are not the villains of this story. A doctor seeing patient after patient in a system that rewards procedures more readily than conversation has little time left for explaining. Paternalism is often less a personal failing than a habit our systems quietly reward.

There is, however, a better way to understand what should sit between a patient and a clinician: a fiduciary relationship. The word comes from the idea of trust. When you place your health in someone else’s hands, expertise gives that person power, but also an obligation to use it in your interest and to give you enough information to make an informed choice.

Nigerian law is less paternalistic than many patients realise. In the 2001 Okonkwo case, the Supreme Court affirmed the right of a competent adult to refuse medical treatment. The National Health Act goes further: healthcare providers are expected to explain your health status, the available options, and the benefits, risks, costs and consequences of those options, in a way you can understand. 

In other words, the right to understand is not a favour a kind clinician grants you. It is already yours.

Five questions to ask before agreeing to a treatment

1. What exactly is wrong and what happens if I do nothing?

This may be the most important question, because it asks whether anything needs to be done at all. Some problems are genuinely urgent: an infection, a badly broken tooth, a suspicious lump. Delay can make these worse.

Others can safely wait.

You are entitled to know which of the two you are facing. Ask what the diagnosis is, how certain it is, and what is likely to happen if you postpone treatment.

2. What are my options and what does each one cost?

It is not small-minded to ask about money. It is part of the decision.

For many, healthcare is paid out-of-pocket. “The best treatment” on paper is not always the best treatment for a particular person if it cannot realistically be completed.

Ask whether there are reasonable alternatives, what each costs, and importantly, what the total cost will be, not merely what you need to pay today.

3. Why this treatment and what are the risks?

Ask what the procedure involves, why it is being recommended, what can reasonably go wrong, and what would happen if a complication occurred.

4. Is anything being removed or done that cannot be undone and is there a gentler option?

A tooth extracted cannot be put back. Tooth structure drilled away does not grow again. 

Some irreversible treatment is absolutely necessary. But irreversible steps deserve a second question before a sign-off.

5. What should I expect afterwards and when should I worry?

Before you leave, know what normal recovery should look like.

How much pain or swelling is expected? For how long? Can you eat normally? When can you return to work? Which symptoms mean you should call or come back immediately?

None of these questions is an accusation. They simply invite the expert to think aloud, in language you understand, about your body, your options and your money.

The clinicians most worth your trust are not diminished by your questions; they are helped by them. Asking is not the opposite of respect. Done well, it may be one of its fullest expressions, the point at which a paternalistic encounter becomes the fiduciary relationship it was always meant to be.

The mouth, I wrote last month, can be one of the body’s most honest mirrors. You should expect the same honesty from the person you trust to care for it.

That was always your right. Let it now become your habit.