How often is it that you don't know if you're expecting a map or a keyword list? I don't think I've ever intentionally put myself in that situation (though it's nice that access supports both).
They say to avoid piping result tuples, but I actually think their example code shows the strength and weaknesses of both approaches. I use pattern matching on tuples when you want more complicated behavior (that might be hard to read in a big else block for a with) and a nice with statement when there's 'one true path.'
In general, I think one of my favorite things about Elixir is that they've done a good job of avoiding adding features you should never use. These all feel like personal judgements about tradeoffs rather than actual hard rules.