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While I adore the doctor who did the SFEMG, he's not an out of the box risk taker. Unless things look like an MG algorithm, he's not likely to declare that it's MG. I'm sure he has his reasons for being that way.
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I am sure he does. It is the easiest to work according to clear and known algorithms. Many physicians also understand the-primum non-nocere (first do no harm, in the Hippocratic oath) in a very simplistic way -don't treat if you are not 100% sure of the diagnosis/Treat aggressively once you are sure of the diagnosis. They do not realize that in some situations no treatment is more harm, then needless treatment. And in others the potential harm of the treatment may far outweigh its benefit, even if it is indicated. The equation is therefore much more complicated.