I think real life medical play has ultimately been more fulfilling than fantasy, but I think there is nuance with this.
I had fantasied about medical-related fetish stuff as an 11-12 year old, though my fascination with it started at like 7 or so. My fantasies were really heavy on a doctor listening to my heartbeat with a stethoscope while I masturbated. My first time having any sort of sexual interaction was at 20 with someone I met on fetlife who was into medical fetish as well. Long story short, I was not prepared for how different it feels to engage with a partner in fetish play in real life from a sensory, interpersonal, and sexual standpoint. It was in some ways a very scary and vulnerable experience because of all the other dyanamics involved, and for a bit I kind of retreated back to fantasy land.
It took a couple months to process this experience, and tried again with meeting medical fetish folks in real life, with overall much better results. I was more prepared for what it was like to engage with another person in something that was very rich in sensory, interpersonal, and sexual aspects. Subsequent play sessions have always been 100% more sexually gratifying than fantasies. To put in another way, my orgasms were by far WAY more powerful in person than when I simply engaged my own fantasies.
Fantasies (personal opinion here) are idealized scenarios that emphasize the sexual aspects and gratification of said scenario but don't truly have the sensory or interpersonal aspects involved. That doesn't make them invalid or wrong, and certainly we should have fantasies and dreams, but we should be candid about what they are and be willing to consider what to do with them or if there is anything to do with them.
I will add that as I've gotten older and more mature, the scope of my fantasies has increased. I take this as an overall good thing, because I am allowing myself to explore new things that I don't think I would have considered pleasing previously. My fantasies give me some food for thought as to what I would like to experience with another person.