In another thread on long hospital shifts, commenters made the point that the detrimental effect of subtle information lost during a shift change often outweighs the effect of sleep loss during a long shift, when looking at patient outcomes.

I wouldn't be surprised if doctors here were gaming the rules because they knew a transfer would cause more harm than good.

On one hand, it's bad to disregard patient autonomy and legitimate guardianship, especially in such an extreme way.

On the other hand, if I was a professional convinced that not doing so would be likely to cause the death of a patient, I can't tell you for sure that I wouldn't do the same thing. The Hippocratic Oath does not say "First, follow the law; Second, do no harm".

>In another thread on long hospital shifts, commenters made the point that the detrimental effect of subtle information lost during a shift change often outweighs the effect of sleep loss during a long shift, when looking at patient outcomes.

>I wouldn't be surprised if doctors here were gaming the rules because they knew a transfer would cause more harm than good.

Well then they could have told the family that was their line of reasoning for not wanting the transfer. If they had a defensible reason they would have worked that angle before using the system to try to make an end run around the patient's/family's wishes.

Hospitals in the UK have for the last few years been receiving training to counter this, based on the lessons learnt by the airline industry - Cockpit Management. This was set in motion by an airline pilot whose daughter died in a hospital because of a mistake made by a senior surgeon who wouldn't listen to the junior staff who had noticed it. The tl;dr of it is that saying "Stop, I think you are making a mistake" is an effective way for junior staff to get senior staff to pay attention, and can save lives.

I'm not sure it's entirely solved.

Anecdote: I had whooping cough a few years ago, unbeknownst to me, during a national whooping cough epidemic, where the NHS had put out a bulletin telling doctors to look out for whooping cough.

During this time I had fits where I wouldn't be able to call an ambulance because of the shaking. I also could have potentially killed infants I came into contact with.

Both the NHS and private doctor ignored the possibility of me having the disease - my partner's mother, a registered nurse, even suggested I ask them to look for it - simply because they didn't think of it when they first arrived.

And of course both the private and NHS doctors arrived late, don't apologise, and insist I call them by their title rather than their name.

My general feeling of the medical industry in the UK is that it has more respect for formality than professionalism.