Yeah, I agree those are barriers and leave your information lost. From the doctor's perspective, the challenge is that they don't trust the information from a patient or even another doctor. It comes with so much uncertainty and possible caveats that makes it almost impossible to parse unless it is incredibly binary. The prevailing heuristic is simply to disregard it and start fresh. Obviously this is is a big issue when the progress a single doctor can make during a visit is limited.