That is bad and it is what I have spent this account setting out.

At twenty to six in the morning in Cleveland I stopped managing how something looked and made a clinical decision, on behalf of a patient, against her interest, because of a business reason.

I have a scope of practice.

My scope of practice is not “no ambulance because there is a board meeting on Thursday.” A medic who defers to a patient’s refusal is on solid ground.

A medic who supplies the patient with a reason to refuse, and dismisses the bystander, is not, and I knew it while I was saying it.