From my experience as an emergency physician, I know there are often pressures influencing the decision to chemically restrain patients, one that I have felt guilty for even entertaining, such as lacking staff to spend the time verbally redirecting patients back to their room or situations like the one I experienced recently when a first responder flippantly asked if I would just give a verbally belligerent guy some ketamine and make “everyone’s life easier.” It should be obvious that using any form of restraints should be a last resort, used only after attempts to deescalate have failed, not just because there are physical risks like extrapyramidal and cardiovascular side effects, but also because restraints limit some fundamental human rights and risk the individual’s long-term mental well-being. One study found that up to 47 percent of people end up with post-traumatic stress disorder as a result of this traumatizing practice.¹

Having now been the victim of this coercive procedure, when it appeared that chemical restraint was used “punitively, for convenience, or as an alternative to reasonable staffing” and without exhausting alternative options, I can now speak from the perspective of the patient on what it feels like to have liberties stripped away, to feel that forced treatment was completely unjustified, to think perhaps it was a means of punishment or an “unnecessary exercise of power,” and to feel utterly helpless and vulnerable.^2–5 Although carrying a diagnosis of depression caused me fear of being discredited and suffering professional fallout, unlike most mental health patients who have no chance of obtaining justice, as it is their word versus the almighty physician’s, I am in a position where I can use my story to promote awareness and change within our medical community.⁶

When I finally had the courage to request and read through my medical records, I was appalled to learn that it was a second female doctor, one I had never met that night, who had the audacity to write in a note that she was medicating me because I was agitated; she wrote that she was doing it for safety reasons. Perhaps she was receiving sign-out at shift change and made a very inaccurate presumption, but this is only my own speculation; there is no other evidence in the chart of her having any form of interaction with me. My story is not meant to demonstrate a rare “bad apple” doctor getting away with malpractice but to call attention to a much more likely scenario: Emergency physicians frequently jump to chemical sedation without exhausting other options or contemplating the ethical and moral consequences of this practice. Further, and perhaps more importantly, when we witness any form of practice that we may find questionable or even outright wrong, we may not speak up because we have learned to be silent. The “hidden curriculum” of our training teaches us not to challenge the hierarchy.^7,8 Meanwhile, patients are losing trust in our health care system; I am losing trust as well. Every day I think about leaving medicine, even though that would only add to the statistics of burnout and the abysmal attrition rate, especially of women, in our specialty.⁹ By speaking out, I hope to once again find my calling in medicine.