If a dog is tied to a bicycle

The senior house officer was fuming: “A&E! They’ve done it again! They’ve sent round an acute coronary syndrome who has blatantly got cholangitis.” He wasn’t prepared to let it go. “You’ve got to say something. This is a waste of our time and our bed.” It was clear that the patient’s initial working diagnosis was wrong and that he needed referral to the surgeons.

But there was little point in being upset; we have to accept that a certain portion of our referrals …