The patients are different. Half of them are very well educated and knowledgeable about their conditions, bringing in lists of diagnoses.
The question I try to address - well, the question I haven't addressed yet, but would like to, is: do these long lists of diagnoses serve a purpose?
I mean, there are lists and there are lists. Let's say
List 1. Diabetes, hypertension, coronary artery disease, depression, tobacco use
List 2. Cervicalgia, autonomic dysfunction, benign prostatic hyperplasia, degenerative disk disease
List 1 is more than the sum of its parts, and list 2 - not so much. Which doesn't mean the problems in list 2 are minor (every one has a right to think that their problems are not minor! why else would they come to the doctor?), just that the multiplicity of the diagnoses is less important.