As near as I can tell, tipping your hand is never helpful. If you feel politely trying to resolve it would be pointless and you have to escalate, do it. Do not warn them. Do not threaten them. Just do it. Clinic managers can be helpful if you aren't at a hospital big enough to have a patient relations person.
Bring an advocate/witness who ideally will take notes of their own, have the doctor document any requests they refuse, and when you get home, follow up with a completely neutral message in the patient portal restating what was stated in the appointment, and asking for confirmation that you understood everything. Even if they do not respond, you at least have an un-alterable account of what was said, time stamped, from very shortly after the appointment.
A lot of places now have rules about recording and while I think this is horseshit (I know why the rule is there but it's still horseshit, we should be allowed to protect.ourselves), and in many places is legal to do without their knowledge, if it is against clinic policy they can fire you as a patient, so be prepared to take that hit if you reveal that you did record something.
State medical licensing boards are moderately helpful. They are of necessity staffed by doctors, not regular people, so they have the same biases as the medical community at large.
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