Why should I tell patients what happens if they do nothing? Because it is a real professional duty, and because nothing is always a legitimate option with any medical service. So I say it plainly. Things do not get better on their own. Then I list back the very complaints the patient told me they dislike, and I explain how each one typically gets worse over time, plus any clinical deterioration that follows. The slipping plate keeps slipping. The shrinking bone keeps shrinking. I am not scaring anyone, I am being honest about the trajectory. The funny thing is, doing this [...]