I think this happens in almost every branch of medicine, and it doesn't specifically require 3rd world hacks. For instance, I have a history of getting peritonsillar abscesses about every other year (basically pre-tonsillitis, the cell barrier around the tonsil has been breached and if I get a bad sore throat, the whole thing turns into a massive abscess that has to be lanced, drained, and I have to be given huge amounts of antibiotics). I can't get my tonsil's removed because the recovery time for an adult is more than a month out of work. Several times now I have gone to the hospital, told the attending doctor exactly what the issue was, how it needed to be treated, what antibiotics work, what anabolic steroid to use, and how much liquified vicodin I need to be able to start eating again (your throat almost swells shut). More than 3/4ths of the time, the attending doctor would tell me it was just strep throat and give me some minor meds. I finally got fed up with it and pay the extra for no-referral insurance. I call the ENT, make an appointment, get my throat lanced, and am relieved in about 3 hours. I think the issue may have something to do with lots of resident hospitals using almost exclusively resident physicians. A resident is not the same thing as a full experienced doctor, and hospitals seem to forget that. Especially when it isn't your usual broken arm, gunshot wound or case of the sniffles.