I haven't had any really bad experiences of this problem. Then again most of my flying is in the UK.
Had a nice situation once in the UK when operating as a hospital flight. We were inbound to the beacon to do the procedural approach when another aircraft checked in and asked for a straight in. "Negative, take up the hold at XX, you are number two for the approach, a hospital flight has priority" the reply was "are you aware that we are also a hospital flight?" and the reply came "Negative, in that case take up the hold at XX, you are just number two."
Fair is fair!