@hawkeye10,
I've been a lucky woman, by virtue of long acquaintance via working in a well regarded med center for years and years, to have had a lot of particularly good mds over time. I get how lucky I was, now that I am financially embarrassed, as they say, and clinic dependent. Still, one of my clinics has been superb, comparable to the care from those sharp types of my yesteryears. Most of those smart types always took time to go over pros and cons, diagramming stuff, with me - but they were advantaged there too, as I am pretty knowledgeable as patients go. I read up back then, too, before google, but from the biomed library, which is where I first read about RP. All of those mds were good listeners, or I'd have been out of there. But how do they do with the less knowing patient....
Interesting to me, at my present eye clinic, I've watched as people in the local incarceration population are in line to see my doc, always with at least one guard who enters the room. These guys get the same amount of time with him as I do, and he is a superb listener, explainer, and listener and explainer again. So, some good medicine is still happening.
The system as a whole - I agree with Robert on his take, last I read of it. No link right this minute. Anyway, I'm not enthused about present efforts at any kind of fix, though I'm more for them than for no change at all.
Oh, wait, this is a digression.