short version, not subtle, very stupid. i had an acute condition with one and only one accepted course of treatment. nurse put in orders to do something very different, which likely would have caused a massive organ rupture if i wasn't keeping track of every minutiae they did while trying to treat me. i refused the new treatment and wasn't harmed, but the MD signed off on it. as it was i left the hospital severly dehydrated because they were refusing me IV fluids while i was NPO.