I think this gets exactly to it, but I don’t agree with the rest of your comment.
In both the provided examples, the fact that there's a request for actionable information is already implicitly understood based on the situation. When a doctor comes into your room, you already know they're checking on your condition. The "How are you?" is just general greeting (to which, in casual situations, the proper response is "Fine, and you?").
And this is the crux of the misunderstanding. The Russian takes it as a request for information when it isn't.
*Edit*: A YouTube video pulled from another comment in this thread that explains what I was trying to say much better: https://m.youtube.com/watch?v=eGnH0KAXhCw&feature=youtu.be
If he's still in a lot of pain then the doctor would expect the patient to say that. "The nurses are treating me well, the food is fine, but I'm still in a lot of pain. Is there anything you can do about that?"
The doctor was asking a question relative to the situation and the Russian interpreted as an absolute question.
This situation is a very common standup joke here in Russia since like the 70s or 80s when some of our movie or theater stars were in the US (or some other 'capitalistic' country) and were constantly asked 'how are you' in a hallway.
Similar when interacting with customer service. They don't want to know how you are, they want to know why you're talking with them, how they need to approach you. If you're calling about your cable bill and tell them you're not doing well because your aunt died, well, that's not actionable by them. They want to know how you're doing in the context of your cable bill. Even if your answer is "good, but I have a billing issue", it usefully sets the tone for the conversation in a way that "bad, Aunt Gerda passed away" does not.