I once had a physician refuse to give me an order to transfer his Pt to ER after the Pt had fallen on the floor in the bathroom, had a large hematoma on his head, was complaining of acute abdominal pain, and had diarrhea for 48hours. The Dr yelled at me on the phone. I sent the Pt out anyway. The ER reported he was dehydrated with electrolyte imbalances (duh). The Dr called me later and apologized. I'm sure he was pleased I had "disobeyed" his order.