Praburam and I try hard to manage all the children ourselves in our hospital and never refer a child. If we need a second opinion we usually send them to Vellore to meet one of our Professors or Specialists we know.
Right now we have a baby on a ventilator and it will be at least three days before we can take him off it. Then out of the blue - TWINS! Born at 32 weeks and very tiny. Both of them had severe breathing difficulty and my gut feeling was that they would not hold on for too long. So I made a couple of phonecalls and sent them in an hour to another hospital. It was a wise decision as a few hours later one of the babies needed to be ventilated.
Later I had a 13 year old guy who came with severe abdominal pain after a fall while running down the stairs. An Xray revealed air under the diaphragm - he had a hole in his intestines. Unfortunately they said they could not afford surgery here and hence decided to take him to the Government Hospital. Both the Pediatric Surgeon and I felt it was OK as we had resuscitated the child well and he was stable.
Inspite of your best efforts sometimes we need to do such things and I guess its an integral part of clinical decision making - prompt decisions and early referrals where needed.
I thank God for the wisdom and the uneventful transport of these childre. Hope they all do well.