I believe that dataset was built off of cases that were selected for being unusual enough for physicians to submit to the New England Journal of Medicine. The real-world diagnostic accuracy of physicians in these cases was 100% - the hospital figured out a diagnosis and wrote it up. In the real world these cases are solved by a team of human doctors working together, consulting with different specialists. Comparing the model's results to the results of a single human physician - particularly when all the irrelevant details have been stripped away and you're just left with the clean case report - isn't really reflective of how medicine works in practice. They're also not the kind of situations that you as a patient are likely to experience, and your doctor probably sees them rarely if ever.