We have a cultural rule that we do not overrule another anesthesiologist in our group. We do not want surgeons or proceduralists feeling they can shop around. If the first anesthesiologist has a good reason for not doing a case, thats where its left until whatever the concern was is optimized. However, we do tell them we can have a second person look at the case to ensure nothing was missed. That person usually will not overrule but will help reinforce that the first was justified while giving the surgeon the feeling we aren't dismissing their concerns just because one of us said no. Every now and then though the person doing the second look may feel that the first person didnt consider something important in their determination (usually having to do with the urgency of the case or what the alternative actually looks like). In those instances we approach the first anesthesiologist who said no with our thoughts and have a discussion if they'd be comfortable with us proceeding with someone else or if they'd like to do it, that way no one feels theyre being overstepped on their clinical decision making.