I read with interest and then concern Dr. Wrenn's article [1]. Having worked as housestaff, attending physician, and emergency room physician, I can vouch for the agony of the "retrospectoscope" and the self-doubt regarding whether the proper decision was made. However, something was even more disturbing about Dr. Wrenn's account.

Dr. Wrenn described a disheveled patient who did not wish treatment. When this patient attempted to leave the emergency room, he was "tackled" by security guards and given haloperidol in order to "control" him. The patient was then admitted to the hospital against his will and eventually died.

Part of the current public backlash against physicians relates to a perception that physicians are arrogant, aloof, and condescending. I suggest that the treatment of the described patient gives credence to this perception. I have been frequently frustrated by patients who refuse what I consider proper treatment. It is, however, unconscionable to respond with physical and chemical coercion. The fact that this patient died afterwards is not the point; it could be strongly argued that this patient was kidnapped, drugged, and subjected to unwilling medical treatment. To my mind, this differs in degree but not in kind from Soviet "mental hospitals" and many of the excesses of the Third Reich.

I had hoped that medicine in the twentieth century had gone beyond coercing patients "for their own good".