Well, what if? Say it enough and the phrase only gains value in vague horror. So this is where I stand on the issue...if you need to talk to me about something important, just say what it is we need to talk about up front.
Example: "hey, we need to talk about your hair...it's scary". Done! I'm not freaking out, I have the subject of the discussion and your opinion on the matter all in the first sentence. No need to worry, no need to wonder. All ambiguity has been removed and we can all go about our business and leave all the "what ifs" out of our lives forever. Doesn't that seem nicer? I think so.