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Don't get fat is all most of what you need to hear, which is advice that can be given by anyone.
  1. That's clearly not all that people need to hear. Do you think patients usually leave their appointments understanding the consequences of treating symptoms with medication vs fixing the underlying problem with a lifestyle change (when that distinction makes sense)?
  2. The source matters. Having this impressed upon you by your trusted doctor, who knows what he/she's talking about and knows what the various options are, is different than hearing it from another place.
I have been told by doctors I know that they don't want to alienate patients by telling them harsh truths. That is what upsets me and what I see as a professional failing. If you know patients are heading towards horrible illness and don't make the effort to communicate it in a way that sinks in, that's a failure.
I was a teacher for several years and it would have been a failing to not communicate to a student that they were on track to fail out, and those stakes are so much lower. Teachers also have lots of students to see and not as much time as they'd like for each.
I hope I'm not coming across as overly antagonistic here. I see the professions I'm part of (education and economics) as also largely failing at their core missions too and I find the blasé attitudes frustrating. My personal experience with the health care industry gives me that same impression.