A couple of former girlfriends would get bent seven ways out of shape when I'd occasionally, gently, but rather forcefully direct them away from perceived trouble, or make hasty departures. It was only after I told them that people speaking inappropriately loud in public are usually either drunk, crazy, or both and I wished to avoid the splatter and spare them as well. When a couple of incidents went predictably pear-shaped as we were making an exit, the grumbling ceased.
I know that people who get obnoxiously abusive aren't that sick or in pain, they're just personally offended that we haven't recognized their inate superiority to the rest of us humble mortals. That judgement has never been disproven in thousands of experiments.
And when you earnestly and precisely announce to me, inside triage while I'm checking your vitals, that you need help breathing, because you're not a bird, because you can't fly; but you are a fish, because you have gills, I know with absolute certainty, despite your denial of prior mental health issues, care, or prescriptions, and despite never earning a license to practice psychiatry, that you are incontrovertably just plain batsh*t nuts.
But just to be scientific, I checked, and nope, no visible gills.
Chief complaint on tracker of "SOB/Blocked Gills" got me a phone call. Hey, it was your policy to have us type it in just as the patient described it. I would have simply put in "psych eval", but noooooooooooo.
The charge nurse was somewhat surprised when I asked for an open aquarium stat, and the doc politely declined my offer to acquire a diving mask for him before his physical exam.