[wahern]

  not an ideal relationship to have with your medical counsel

It's a reasonable relationship to have considering you'll only spend an hour or so a year in direct consultation. In some sense it is ideal. He's putting you on notice that you can't rely on his advice in such a context because he has neither the access nor the diagnostic resources to personalize his advice, neither in the moment nor especially on an ongoing basis. Time budgeting is at the root of many professional relationships and their tensions. If you want more personalized advice, you have to be prepared to pay for it.

I've run some ideas past doctors and have always tried to make clear that I understand any thumbs up or thumbs down is contingent on the absence of complicating factors. But that's a difficult position in which to put a doctor, lawyer, engineer or most any other professional. Even if they agree to play along, the value of their affirmation is questionable.