> In the second, I don't understand as no competent licensed doctor chooses the treatment options (absent an emergency); they presumably know the only reasonable options, discuss them with the patient, answer questions, and the patient chooses.
I wish that were the case, but in my experience it is not. Every time I've seen a doctor, they offered only one medication, unless I requested a different one.
I've had a few doctors offer me alternatives and talk through the options, which I'll agree is rare. It sure has been nice when it happened. One time I did push back on one of the doctor's recommendations: I was with my mom and the doctor said he was going to prescribe some medication. I said "I presume you're already aware of this but she's been on that before and reacted poorly to it and we took her off it because of that. The doctor was NOT aware of that and prescribed something else. I sure was glad to be there and be able to catch that.
First is that the side effect profile of one option is much better known or tolerated, so the doctor will default to it.
Second is that the doctor knows the insurance company / government plan will require attempting to treat a condition with a standard cheaper treatment before they will pay for the newer, more expensive option.
There's always the third case where the doctor is overworked, lazy or prideful and doesn't consider the patient may have some input on which treatment they would like, since they didn't go to medical school and what would they know anyway?
I wish that were the case, but in my experience it is not. Every time I've seen a doctor, they offered only one medication, unless I requested a different one.