Doctors have to show continued professional development every year for Revalidation of their license. It’s hard to keep on top of all the research, there is so much of it. Much of it of arguable quality, and contradictory making it hard to interpret. Generally people follow guidelines and advice from experts unless they are the expert in that are due to this. And doctors are culturally quite cautious, preferring proven treatments/ideas than new ones, partly from being burnt by previous “great” ideas (e.g. thalidomide), and due to the risk involved.

In my experience as a patient trying to deal with a chronic illness. Doctors, like many professionals, seem to have a strong preference for methods that seem to work for them.

Crucially I don’t think there’s a strong feedback loop for specialists. I was frustrated with my urologist. I just got a 2nd (and 3rd) opinion. But the information of “what you were doing hasn’t been working for me” didn’t make it back to my doctors. In part because it takes months to schedule an appointment. They also probably assume if they don’t see me, it just got better. This is partially because medicine is hard and there’s so much subjectivity in patient experiences. Crucially these specialists are in high demand, so they will find work, even if they really are just marginally effective.

Maybe there’s more “feedback” than I see, but That’s just my 2 cents from the patient perspective.

What you say is also true. Often, if patients don’t return we assume it has resolved itself, partly because it sometimes does (especially minor complaints) and partly as pragmatically its hard enough to keep up with current workload. I agree doctors do what works for them, and think both of what’s good for the patient and what they could be sued/penalised for and how to avoid that harm too. I think this sometimes leads to worse outcomes but you have to work in the system you are in. I guess part of the difference between a good doctor and a great one is knowing when to pry more, find out things aren’t working and try something different. Sorry for your bad experiences. I think there are more good doctors than we think out there, it’s just the system and workload ruin it for everyone.