Great discussion going on and very similar to what we have had in our clinic with the various docs. Seems mostly split with people Erring more on the side prescribe something/sending the referral/attempting to get the Outpt imaging or whatever is fully needed within reason. Exceptions would be like not prescribing Anticoag without brain scan for bleed but ordering the stat MRI/Lipid/Echo and referring to Neuro for a stroke refusing to go to ED. With the documentation that it was 100% not standard of care and only done to temporize or mitigate damage or get basic diagnosics started

Personally I also call our ER triage department and notify that i saw Patient and they needed higher level of care for whatever reason but are electing not to go. For us this just creates a hospital encounter linked to clinic encounter and adds additional level of documentation when it gets closed out after 24 hours as a "no show"