Sometimes patients want to be reassured and told that there is nothing they should be concerned about.

Sometimes the diagnosis is not straightforward, and the expectations of the patient influences the physician's decisions (physicians are people after all, and so are patients).

I have seen two patients in my clinic recently. Both with fairly similar complaints which could be anything from a minor temporary problem to the first signs of a more serious condition.
One wanted every possible test to be done and consulted numerous physicians (getting very conflicting information), and the other was very happy to know that I have found nothing wrong and hardly agreed to even come for a follow-up visit.

I know that I myself, when I was referred to an MG expert, wanted him to tell me that this couldn't be MG and a few days of vacation is all which is required.
And this is exactly what he said. I had vague symptoms (at that time), a normal neurological examination and a history of similar symptoms years before, which turned out to be "nothing". He also suggested that he would do an EMG or that I could try taking mestinon, but I just asked him to write a letter to my endocrinologist telling him that this is not MG. And he gladly did that.

What I am trying to say is that no doubt that some physicians forgot why they decided to be physicians (or maybe chose this profession for the wrong reasons) but there are many who didn't.

I don't know Dr. Howard, so can't say anything specifically about him, but you don't know what kind of interaction he had with your sister. MG is a fluctuative illness, which improves with rest. Possibly he saw her at a relatively good time. Some people try to let their neurologist see them at their worst and others do the exact opposite.

I don't know how severe your sister's symptoms are or how much they interfere with her life. If they don't too much maybe she is doing the right thing. I had mild MG symptoms 20 years ago, and they disappeared without treatment for 15 years.

It is hard to know what my life would have been like, if I was given steroids then. Possibly it would have led to severe deterioration in my condition (like it did now).

When I was a young fellow and very eager to treat a patient I saw in my clinic, the head of my department said to me- It takes an excellent physician to know when and how to treat a patient, it takes an outstanding physician to know when not to give treatment.
Most physicians tend to put more emphasis on the potential benefits than on possible risks. Very few truly weigh both and are honest enough with themselves to admit that they have very little to base their decision on.

I am very fortunate that after quite a few years of having excellent physicians taking care of me, I now have an outstanding one.