What ever happened to the primary rule of 'First Do No Harm'. Keeping the patient's best interests in mind at all times will always steer you in the right direction. It would be one thing if Tom lied to the patient in order to perform an invasive procedure that may have had a negative outcome, but telling a small mistruth merely to TRANSPORT the patient to somewhere where definitive diagnostics are available seems to be a no brainer. What could the patient possibly sue for anyway ? Illegal transportation ? It would seem to me that in any such case, the two most important factors are the outcome of the patient and the intent of the deception. If you can clearly expect that the patient outcome will be radically different (i.e life vs death), and your intent in 'persuading' the patient through a small deception is purely their own well being - then I'd say your conscience is clear. As we all know, failure to act or patient abandonment is also a punishable offense, so in some respects you are damned if you do and damned if you don't. Out there in the real world, there's some kind of improvisation that occurs on almost every call. People who would be critical of Tom's actions must have never stood in his shoes.