@cjs56, seems from your posts that it would be helpful to have an ethicist on Hint Community, lol!
1. First of all, do what you understand to be right! For the patient, morally, medically, emotionally, legally and financially... and probably in that order.
2. You may need to consider another employer, especially if you are constantly being put into these ethical binds.
3. The good ole days seem to be gone. It used to be for us country family physicians that we ran the office, did house calls and nursing home visits, pre-and post-office hospital rounds, managed the ICU, saw our patients in the ER and delivered (NSVD or C/S) our own babies and resuscitated them. We also went to our deceased patients' wakes or funerals. Nowadays, everything is passed off from one provider to the next and the latter blames the former for "dumping" and the former blames the latter for "laziness". As one of my former partners used to say about Christian doctors, but I think it should apply to any physician, "The Christian physician should do what is right, no matter in which delivery model he/she finds themselves." And by "right" I mean by the patient.
4. Understand that there are consequences, not only for doing what is wrong or right, but also for doing what is expedient vs what is thorough. Be prepared to face them... even the bad consequences are best faced when you are firmly convinced that you did what you knew to be best/right.
Once again, a few rapid fire, random thoughts.