I work in a hospital serving an immediate community of about 60,000 with a drawing area from smaller towns of about 150,000. We are situated about 30-40 minutes from a larger population center, with multiple hospitals. Unfortunately, there is a pervasive belief among our population that the larger city has better doctors. I am here to tell you that that is false. The only real advantage to larger hospitals is more services available. A larger hospital allows mediocre physicians to do fairly well, simply because they can consult additional physicians from a larger pool of specialties to cover their ass. Yet the myth remains.
A major cause of transfers is family unhappiness with their current care. Quite often, the family (wrongly) believes that we are doing something wrong because the patient is not getting better fast enough for their liking. These people have watched too much TV, for the most part. Most of getting better in a hospital is simply waiting for the medicines we have given them to work. It takes time and people nowadays are used to immediate gratification. We will try and accommodate them, within reason, by calling other hospitals and seeing if they will take the patient, but if we are doing everything correctly and there is nothing more to be offered from the transfer, they are under no obligation to accept.
Nurse: "The family in bed 13 are wanting a transfer to Big Hospital."
Me: "I have already talked to Big Hospital twice about that. They told me we are doing everything they would and they wouldn't accept."
Nurse: "They're insistent."
Me: "Tell them to call Big Hospital then and get a physician to accept. I'm done trying to arrange that."
*few hours later*
Nurse: "Ok, the family found someone to accept."
Me: "What is the physician's name?"
Nurse: "Dr. Challenged."
Nurse: "Why is that funny?"
Me: "Because we fired that guy from here for incompetence."