To the Editor: In his thoughtful essay on arrogance, Dr. Ingelfinger confronts the tension between autonomy and expertise that exists in the physicianpatient relation. His description of the patient who personally shoulders all the burdens of medical decision making may have been influenced by his own highly atypical predicament — one doubts that a physician with such an eminent gastroenterologist as a patient could respond in the same way that he or she would respond to other patients. In any case, Dr. Ingelfinger's analysis might be taken to imply a false dichotomy: the arrogant, authoritarian physician who tolerates no patient. . .
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