Do I really need the operation?" Pascal D'Souza, a young computer engineer, asked after I suggested a minimally invasive spine surgery for a sizeable slipped disc in his lower back. It was pinching on his nerves and his condition hadn't improved despite a course of medication and physiotherapy. The pain was shooting down his legs as if he was being "stabbed repeatedly". He could barely sit still, and contorted like a novice gymnast into a posture that led to least discomfort.

"How many such operations have you performed and how many have been successful?" he asked, perhaps condescendingly, as he discretely turned on his iPhone to record the conversation. I don't object to being taped, so he did not perturb me. "What if I get paralysed or lose urinary control? I've Googled the risks of surgery and I'm not willing to do it unless you give me a guarantee in writing."