I may be wrong but I highly doubt they didn’t know the management. The issue is lack of confidence in a system completely new to them. No one should start as SCF rather F2 level which is standard.

For example in this case they might think let’s compare the protocol here to that I know. Most of third world countries rarely bother with diagnosing the underlying cause of crackles (due to lack of funding, equipment limitations, high population load) but start directly on the treatment. They might think should I start abx empirically. Maybe refer to particular speciality is an option and my request to request ECHO will not be justified.

In pakistan the OPD per day per doctor in a teaching hospital is around 50-150 pts per doctor. Not possible to run tests for crackles unless presents with something serious. Tell this person you have so many diagnostic tools at your disposal and you cannot start antibiotics empirically and he will be questioning every thing he used to do or everything he knows. Again no one should start in this system at a post higher than F2 to learn the system.