So there you are. Sitting in a frigid waiting room staring at the clock.
Each time the second-hand moves it seems to clang louder and louder.
Tic-Toc. Tic-Toc.
As you rub your sweaty hands together suddenly your name gets called out, which causes your stomach to hit the floor.
Then you suck in a big gulp of air and take the long walk into the examination room. Eyes glued to the medical assistant’s heels as you hope, wish, and pray that you don’t panic.
But I’m not writing to tell you that some people get nervous when they see a doctor. We all know that happens. I want to tell you about much more than that.
What’s White Coat Syndrome?
Some people, maybe you, also get high blood pressure when they’re in their doctor’s office. It’s called White Coat Syndrome (WCS), or White Coat Hypertension.
The most common symptom of white coat syndrome is elevated blood pressure while you’re at your doctor’s office, but not when you’re anywhere else.
What’s considered high blood pressure? It varies depending on who you ask, but in general if your blood pressure hits 140/90 then you have high blood pressure, which is also known as hypertension.
In this regard, white coat syndrome is situational, like the fear of flying for example.
It’s also a specific phobia that most people decide not to treat because in most cases it doesn’t stop you from doing what you have to do on a daily basis.
Key Points
WSC may cause:
- Panic
- Fainting
- Fear of losing control
- Fear of dying
WSC is caused by:
- Past trauma
- Fear conditioning
- Repression of emotions
- Pre-existing anxiety issues
Why it Matters
Some studies have shown that people who suffer from WCS may have an increased risk of cardiovascular disease over the long-run.
It’s not as bad as having sustained hypertension, but the risk is there nonetheless, so it should be addressed.
Plus, having WCS also means that you’re more likely to put off preventative or routine appointments to see your doctor, which could increase your chances of missing or ignoring minor issues that could develop into a big problem over time.
Of course, there are things you can do to reduce your intense fear of the doctor, blood pressure cuffs, or even waiting rooms. I reviewed treatment options for WSC in a recent podcast.
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References
Brayer, T. (2011). About white coat hypertension. Retrieved from: https://getbetterhealth.com/about-white-coat-hypertension/2011.02.21
Chung, I., Lip, G. (2003). White coat hypertension: Not so benign after all? Journal of Human Hypertension, 17, 807-809. doi:10.1038/sj.jhh.1001651. Retrieved from: https://www.nature.com/jhh/journal/v17/n12/full/1001651a.html
Landray, M., & Lip, G. (1999). White coat hypertension: a recognised syndrome with uncertain implications. Journal of Human Hypertension, 13(1), 5. Retrieved from EBSCOhost.
Klausch, T. (2009). Phobias and overcoming phobias. Retrieved from: https://web4health.info/en/answers/anx-phobias-general.htm#phobias
Very interesting topic, Paul. Haven’t really heard much about this one. I don’t it affects me, personally… but I do recall right before a hernia surgery I had… my BP was off the charts. (high.) I generally run on the low side, almost too low. So, that was interesting.
This is good stuff and I expect some will find an “a-ha” moment with this podcast.
Great to hear a new show, and I look forward to the next one!
I think I have WCS to a certain extent. Going to the doctor does make me nervous, since I’m an anxious person and a hypocondriac. I can feel my heart pounding in my chest when I’m called into the doctor’s office. But surprisingly (and, I guess, thankfully) my blood pressure always remains normal. Which is kind of ironic since one of my fears when I go to the doctor is being told I have high blood pressure.
But yeah, I’ve heard about WCS before, and what I think is really sad is that most doctors don’t do anything to make you comfortable, like they are a) completely unaware of WCS or b) they simply don’t care that some patients may be nervous.
Thanks for an interesting topic, Paul. That’s an international syndrome, because it wide spreads in Ukraine too. In my opinion, this is one of the funniest phobias. White coat is treated with respect and awe.
Paul,
Your site and podcasts are awesome. Thanks so much for your site and all the great info. I do suffer from white coat syndrome, not with blood pressure so much, but with awful anxiety and panic when I go to the doctor. I have trouble going for routine appointments, never mind having any kind of test like the routine colonoscopy I’ve put off for 2 years now. I’ve been going to therapy for about 10 months and have discovered that both my parents getting cancer diagnoses and dying from cancer has made me very afraid of going to the doctor. I did have my checkup last year and all was well, but I continue to have these fears. The therapy has helped tremendously, but I think now I need to do some cognitive behavioral stuff, which is the hard part. You would think that having lost my parents to cancer that I would want to be checked for anything and everything, but the panic gets in the way. Thanks again for your great info and encouragement. I loved the part of the podcast where you say it’s not ebola after all! That gave me a much needed laugh and when I do go to the doctor next month for a scheduled visit I will think about that when I’m sitting in the waiting room!
Hey Paul,
I have not experienced MCS myself, but I can see how it can be a phobia given the sensations associated with it.
It would stand to reason that using the techniques you talk about would be of great benefit to this population.
Thanks for the info. Have a great day.
@Kimmie, Your comment made me smile big! So glad you enjoyed the podcast. And remember that at the end of the day, it’s better to be afraid but always know your health status, than it is to be afraid and not know.
At least if you know your health status problems can be caught early and treated with greater success.
@Oleg, Yes I think the white coat still does get a lot of respect. In a way, doctors are like modern day magic makers; they’re like shamans or something.
lol.
Hello, I think your site might be having browser compatibility
issues. When I look at your blog in Safari, it looks fine but when opening
in Internet Explorer, it has some overlapping. I just wanted
to give you a quick heads up! Other then that, awesome blog!
Paul,
Last year i went to a cardiologist and he gave me a clean chit for heart. But he told me my elevated BP was a WCS and put me on betalock for just 5 days, at the end of the last dose I became hypotensive, meaning to say my BP was not resistant but labile. Gradually i made lots of lifestyle changes like cardioexercises and weights, fish oil, bcomplexes, entertainments, etc. I was so confident of my athletic abilities and the power of exercise to overcome any ailments. Exercising sufficiently everyweek made me forget my anxiety and i forgot all about heart anxiety.
For the past one fortnight i could not exercise on account of orthpedic problems. Yesterday i was forced to stay awake all night and to top it i developed a gastric infection. When i consulted a physician he gave me antibioitics and despite my protestations against taking a BP he took one and the reading showed pretty high. He panicked me contrary to my protests that i have a WCS and that last month the reading was a mere 130/60, and that i had not slept the night before, and the diarrhea had produced a lot of stress in me. He wants to watch me for a few more days before starting me on a antihypertensive.
Should i consult a doc and go on antihypertensives or should i merely depend on lifestyle changes. Secondly is it wrong to depend on antihypertensives life long. Do they cause exercise intolerance. Pls do reply because your responses put me at ease.
Hi Plutoproserpina, although lifestyle changes can and do help a lot, there are times when medications are needed. I recommend that you allow your doctor to complete his/her observation and see what they recommend. If you’re not confident in their recommendation you can always get a second opinion.
Dear Paul
Thank you so much for your reply. I garnered the courage and instead of burying my head under the sand with an excuse of white coat hypertension, i did go to the doctor and she confirmed my BP as high. I was put thorugh a MD Internal Med and he advised me the below.
1. That i have the Medical School student and am unneccassarily confused
2. He assured me there are no physical diseases in me and put through a color visual exercise while taking my BP so as to avoid WCS.
3. He put me through Amlodipine 5 mg for a week and asked me to take an EKG and urea and creatinine.
I did the same. Before taking the EKG i had been to the gym and worked real hard and had walked nearly 3 kms. The Ekg came out fine. I am awaiting the urea and creatinine. Thanks a lot.
Sorry the point 1 should read as Medical School syndrome.