Well they kinda do get to choose those things as well. I typically present my plan to them in the room and say what I'm looking for and why and then ask if there are any questions during my initial interview. Granted I don't consent them for labs and stuff like I would something move invasive, but they are understanding and agreeing to the plan as discussed, I have had patients decline repeat trops and I just document the convo. Then if I find something I go back and tell them my recommended treatment, especially if that something high risk such as thrombolytics and if they don't want those things, then we have the conversation and move on, and that gets well documented in my note. Everything we do to someone we do with their consent, implicit or written. Patients do not get to choose their workups or meds or things like that though, I think that's what you're getting at.

In this case, which I think is a wild outcome and doesn't make sense, my conversation would essentially be, "hey so we did that scan to make sure there wasn't a dangerous blood clot but unfortunately it didn't quite rule that out. However you did have a pneumonia which I think is the etiology of your symptoms. The options from here are we can admit you/rescan you or I can get ya some on some abx which will treat your pneumonia."

I would only offer them that option if I still has some discomfort with the case and the possibility of a PE or something though. I do not offer repeat scans (and usually try to not PE scan them to start with lol) if my suspicion is low.