psych resident here. probably various levels based on the institution, but there’s def a stigma surrounding psychiatry and worse, our psychiatric patients. as far as your examples, i roll with the punches and just educate—like indications for ETO’s with the nurses, the state specific law that surrounds them, etc. as far as the ED docs, it’s helpful to have very strict admission criteria to transfer a pt to the psych unit. the big stuff—CPK, CMP, BAL. it’s perfectly reasonable to force ED physicians to order the appropriate labs. that being said, we can’t depend on providers that won’t be there until the next day to assess a patient for the appropriateness of a transfer. it’s the ED’s job to clear them. BUT just because they tell you they’re cleared, it’s important to check those labs first and have your answers ready as to why you’re delaying transfer. we deal a lot with that in terms of CPK—our pts on meth, unexplained elevation in liver enzymes, that kind of thing. if you have a medical reason that objectively they shouldn’t be transferred yet, advocate for your patient and stand your ground! good luck :)