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I suggest you to start with one of the pre-packaged physics lists. For medical physics with proton/ion beams QGSP_BIC_EMY is a good starting point.
I'm not an expert, but you may be interested in reading the README file provided with examples/advanced/hadrontherapy code, it discusses a bit physics lists.
I do not think you need to make any modification to reduce step size, but be aware that it is a good "rule of thumb " to have productions cuts not larger than the typical dimensions of the most critical geometry objects (you may want to consider checking results with a tracking cut scan for final productions). In your case I would set a production cut smaller than 10um (not too small), e.g. try with few microns. Also in this case try to see the hadrontherapy example of G4 and see what they do there (other good examples for medical physics are extended/medical/electronScattering and extended/medical/electronScattering2).
Hope this helps, Andrea