you should never go to a hospital when you are sick. sick people are unable to play the game. of course when healthy people don't need to go, they don't need to go.
there's a great asymmetry of information between doctors and patients. both players also have complex and unclear motives. doctors want to make patients better, but they also must balance the agenda of the entity paying for the care, the harmful side-effects of treatment, and the fact that they don't know what's wrong with the patient.
the patient wants to get better, wants to avoid harmful side-effects, and wants the best possible treatment. the patient also doesn't want to cause another patient to miss critical treatment.
let's say there are 10 patients who have hit their head against the pavement in bike accidents. the doctor has one slot open at the X-ray to check for fractured skulls.
if all patients seem to be doing fine, no one needs to be sent to the x-ray. if more than one patient however is suspect, the doctor must decide which one to x-ray. if he leaves a fractured skull without x-ray it's
bad. if the doctor has a healthy skull x-rayed, the patient misses an hour of work, and is exposed to a small amount of toxic radiation.
so, what should the patient say when they go to the doctor after their bicycle accident? different people exhibit different personalities and different levels of stoicity and talkativeness. the doctor must be able to make his/her decision without really knowing the patient.
if the patient feels only mild symptoms, and has checked the web to see that mild symptoms are generally not associated with serious hidden consequences, then it is in the interest of the patient to let the doctor know what his personality is, and what he feels his actual symptoms are, and let the doctor decide. knowing the patient's personality the doctor then has a frame of reference against which to measure the symptoms described and is able to tell whether this person needs the x-ray or not.
if however the patient has more severe symptoms, which are more likely to be associated with a hidden condition, such as a fractured skull, which can only be revealed by an x-ray, it is in the patients interest to ensure that he gets the available x-ray slot.
the patient can now study the symptoms associated with a powerful concussion, complain excessively about these, and try to persuade the doctor to x-ray him. the patient is now playing against all the other patients, who are candidates for the x-ray. the doctor is likely to choose the most vocal complainer. someone who has been hit on the head so hard he has lost his ability so communicate may not be able to explain his condition to the doctor and will miss out on the x-ray, or will have to wait another day, which may worsen his condition.
so, it's a prisoner's dilemma situation. where uncooperative play is rewarded.
in the previous example the unnecessary x-ray carries a small penalty. but what if the condition is a painful knee. there is one slot open for knee surgery. the penalty of performing surgery on a knee that is in pain, but does not require surgery is great. this puts the patient in a difficult situation, since he wants the best possible diagnostic tools: x-ray, MRI, etc. but no surgery, unless it is actually required.
however, the patient cannot leave himself at the mercy of the system either, since his actual symptoms will certainly be vague and difficult to describe, and without any conscious effort to secure treatment he will be given painkillers, 3 days sick leave and told to come back if symptoms do not subside. if the condition turns out to be mild, it will heal by itself. if it is not mild, it will become harder to treat and the healing process will be more extensive than if treatment had been started immediately.
so, in the end, because of limited resources in certain parts of the ecosystem, the value of the doctor diminishes, and the patient must take on dangerous parts of the doctor's role in diagnosing and researching his own ailment.