Doctors study this all their lives so they're prepared. You as the patient must clarify in your head or on paper the points you want to get across. If you have a clear agenda, you're more likely to be satisfied. Patients must also insist on explanations and speak up when the physician does something offensive. You don't want to fight, but you want to negotiate.
Doctors like to be appreciated and respected just as anyone does.
HMOs have spurred interest in the subject from a marketing standpoint.