It doesn't have to in some ways at least thankfully

I feel you re:MDs, part of my reality is that my dad died five years ago because a doctor "misdiagnosed" a condition which happened to give that doctor a pretext to install an expensive, profitable device in his chest.

There are definitely shitty people who only cause misery. Part of why I'm comfortable with just ignoring them as opposed to pursuing something (both criminal+civil） is the knowledge that even though I could completely blow up their little world there is nothing I or anyone could possibly do to fuck them worse than they fuck themselves. They're miserable now, I could make them marginally more miserable but the cost would be my own happiness. They aren't worth it; on top of that when you make it apparent to a person who loves to say "do you know who I am" that they aren't worth your time or energy pisses them off just a bit more too.