The Myth of “White Coat” Hypertension


Here’s the scenario:  you arrive at your physician’s appointment five minutes ahead of schedule.  You check in with the receptionist then take a seat in the waiting room.  You catch your breath and sit quietly for a while.  Then you begin to get restive so you search through the magazines and find one that’s moderately tolerable.  Half your mind is on reading, the other half is wondering how long you’ll have to wait.

You watch the television that is tuned to CNN and wish it was something less unpleasant than the latest disaster.  News is mostly bad news, and why is your doctor hammering bad stuff into you?  Why not PBS?  And why aren’t you allowed to change the channel?

You wonder if there’s time to go downstairs and get a cup of coffee.  You don’t know, so you continue to sit.  You wish you’d brought a book of your own.  You think about the paperwork you could be doing.  You wonder how much longer this is going to take.  You check out the other people in the waiting room, trying to figure out who is waiting for which physician and how many others are waiting for your physician.  You think about making some phone calls but you’re not allowed to use your cell phone.

You’d like to ask the receptionist how much longer you’ll have to wait but she was edgy with the last person who asked so you don’t.  You need to use the bathroom but you know from experience that the door is locked between the waiting room and the rest of the suite where the restrooms are.  You’ll have to leave the waiting room and go down the hall to the public restrooms.

Finally the nurse calls you into the treatment room and checks your vital signs.  She says your blood pressure is high and asks how long it’s been that way.  You try to remember whether anybody told you what your blood pressure was the last time you went to a physician.  The nurse leaves the room—and leaves you alone to reflect on hypertension:  do you have it?  What are the consequences?  Did anybody in your family have it?  What’s the treatment?  What’s the damage if left untreated?  What’s the cost to treat?

The physician comes into the treatment room.  If he’s a bad doctor, he’ll address your hypertension and prescribe medication.  If he’s not such a bad doctor, he’ll wait seven or eight minutes, check your blood pressure again and note that it’s nearly normal.  He’ll smile somewhat condescendingly and tell you that you have “white coat” hypertension.

You ask what that is and, with a little gentle patronization, he replies that some people get anxious about seeing the doctor, that is, the big guy in the white coat.  You thank him for the explanation, while both feeling a little ashamed and suppressing some anger.  You are not a child and you’re damn well not afraid of the doctor!

One day I was reflecting on the normal human need to have a reasonable amount of control over one’s circumstances and it hit me:  there’s no such thing as “white coat” hypertension.  There is the hypertension that results from being held captive and denied all control over your situation.

The door is locked so you can’t go in.  If you go out, they may call you while you’re gone.  You can’t turn off the television or turn on your cell phone.  The human element, i.e., the receptionist, is not friendly.  And—most importantly—you have no idea how long you’ll be trapped in this situation.  Half an hour, or an hour and a half?

The reason convicted felons don’t have hypertension is because they know how long their sentence is; there’s a terminus to the time to be served.  You, however, are locked in one small room with no end in sight.  Not having any control over your circumstances is what makes you stressed and causes your blood pressure to go up.  The only reason it’s called “white coat” hypertension is because arrogant egocentric physicians think that everything that happens within a hundred yards of them is because of them.

Physicians’ waiting room hypertension is the worst type because of the staff uncooperativeness (dare we call it hostility?) but you will find it in every situation where all control is taken away from you and you are left waiting with no end in sight.  Consider, for example, the Dept. of Motor Vehicles waiting room.  Need I say more?  How stressed are you by the time they call your number and you go to the window?  What would you guess your blood pressure is?

You get the same thing in a restaurant with a line of people waiting to be seated.  They wait and wait, never knowing for how long.  Should we continue to wait?  Should we try another restaurant?  I watched it happen at a concert that didn’t start on time.  No announcement was made about the cause of the delay or how long it would last.  Can I go out for a drink?  Should I wait?  Do you want to leave?  Same thing as the doctor’s waiting room.  You’re trapped without enough information to make a decision.

My hypothesis can be confirmed very simply:  check blood pressures as soon as people arrive in the waiting room and again when they finally see the physician.  How much do they go up?  Alternatively, note the time the patient arrived, how long s/he waited, and blood pressure at the time of seeing the physician.  Height of blood pressure will correlate with length of wait.  Or write a grant, get funding, and go check blood pressures at the DMV and some restaurants.

So what’s the solution?  First, the physician could stop over-booking so she can see her patients on time.  Alternatively, she could keep the receptionist informed so that when the patient arrives, the patient can be told how long the wait will be.  All the doctor has to do to “cure” white-coat hypertension is give the patient updates every fifteen minutes, and with each update give the patient the option of continuing to wait or rescheduling.

This is not brain surgery.  This is the simple courtesy that your mother taught.  Judging from their behavior, physicians didn’t have mothers.  Your lawyer, pastor, and kid’s school teacher don’t keep you waiting more than fifteen minutes.  Why does your physician?

The director of an inpatient psychiatric unit said one of her hardest jobs was getting her staff to understand what they had done to precipitate the patient crisis.

One of the fundamental things us naked apes need in order to stay healthy is information and the opportunity to make choices.  If doctors want to help us, that’s one place they can start.

Oh yeah—and stop dumping drugs on us for diseases we don’t have.  We’re just reacting to your rudeness.Here’s the scenario:  you arrive at your physician’s appointment five minutes ahead of schedule.  You check in with the receptionist then take a seat in the waiting room.  You catch your breath and sit quietly for a while.  Then you begin to get restive so you search through the magazines and find one that’s moderately tolerable.  Half your mind is on reading, the other half is wondering how long you’ll have to wait.

You watch the television that is tuned to CNN and wish it was something less unpleasant than the latest disaster.  News is mostly bad news, and why is your doctor hammering bad stuff into you?  Why not PBS?  And why aren’t you allowed to change the channel?

You wonder if there’s time to go downstairs and get a cup of coffee.  You don’t know, so you continue to sit.  You wish you’d brought a book of your own.  You think about the paperwork you could be doing.  You wonder how much longer this is going to take.  You check out the other people in the waiting room, trying to figure out who is waiting for which physician and how many others are waiting for your physician.  You think about making some phone calls but you’re not allowed to use your cell phone.

You’d like to ask the receptionist how much longer you’ll have to wait but she was edgy with the last person who asked so you don’t.  You need to use the bathroom but you know from experience that the door is locked between the waiting room and the rest of the suite where the restrooms are.  You’ll have to leave the waiting room and go down the hall to the public restrooms.

Finally the nurse calls you into the treatment room and checks your vital signs.  She says your blood pressure is high and asks how long it’s been that way.  You try to remember whether anybody told you what your blood pressure was the last time you went to a physician.  The nurse leaves the room—and leaves you alone to reflect on hypertension:  do you have it?  What are the consequences?  Did anybody in your family have it?  What’s the treatment?  What’s the damage if left untreated?  What’s the cost to treat?

The physician comes into the treatment room.  If he’s a bad doctor, he’ll address your hypertension and prescribe medication.  If he’s not such a bad doctor, he’ll wait seven or eight minutes, check your blood pressure again and note that it’s nearly normal.  He’ll smile somewhat condescendingly and tell you that you have “white coat” hypertension.

You ask what that is and, with a little gentle patronization, he replies that some people get anxious about seeing the doctor, that is, the big guy in the white coat.  You thank him for the explanation, while both feeling a little ashamed and suppressing some anger.  You are not a child and you’re damn well not afraid of the doctor!

One day I was reflecting on the normal human need to have a reasonable amount of control over one’s circumstances and it hit me:  there’s no such thing as “white coat” hypertension.  There is the hypertension that results from being held captive and denied all control over your situation.

The door is locked so you can’t go in.  If you go out, they may call you while you’re gone.  You can’t turn off the television or turn on your cell phone.  The human element, i.e., the receptionist, is not friendly.  And—most importantly—you have no idea how long you’ll be trapped in this situation.  Half an hour, or an hour and a half?

The reason convicted felons don’t have hypertension is because they know how long their sentence is; there’s a terminus to the time to be served.  You, however, are locked in one small room with no end in sight.  Not having any control over your circumstances is what makes you stressed and causes your blood pressure to go up.  The only reason it’s called “white coat” hypertension is because arrogant egocentric physicians think that everything that happens within a hundred yards of them is because of them.

Physicians’ waiting room hypertension is the worst type because of the staff uncooperativeness (dare we call it hostility?) but you will find it in every situation where all control is taken away from you and you are left waiting with no end in sight.  Consider, for example, the Dept. of Motor Vehicles waiting room.  Need I say more?  How stressed are you by the time they call your number and you go to the window?  What would you guess your blood pressure is?

You get the same thing in a restaurant with a line of people waiting to be seated.  They wait and wait, never knowing for how long.  Should we continue to wait?  Should we try another restaurant?  I watched it happen at a concert that didn’t start on time.  No announcement was made about the cause of the delay or how long it would last.  Can I go out for a drink?  Should I wait?  Do you want to leave?  Same thing as the doctor’s waiting room.  You’re trapped without enough information to make a decision.

My hypothesis can be confirmed very simply:  check blood pressures as soon as people arrive in the waiting room and again when they finally see the physician.  How much do they go up?  Alternatively, note the time the patient arrived, how long s/he waited, and blood pressure at the time of seeing the physician.  Height of blood pressure will correlate with length of wait.  Or write a grant, get funding, and go check blood pressures at the DMV and some restaurants.

So what’s the solution?  First, the physician could stop over-booking so she can see her patients on time.  Alternatively, she could keep the receptionist informed so that when the patient arrives, the patient can be told how long the wait will be.  All the doctor has to do to “cure” white-coat hypertension is give the patient updates every fifteen minutes, and with each update give the patient the option of continuing to wait or rescheduling.

This is not brain surgery.  This is the simple courtesy that your mother taught.  Judging from their behavior, physicians didn’t have mothers.  Your lawyer, pastor, and kid’s school teacher don’t keep you waiting more than fifteen minutes.  Why does your physician?

The director of an inpatient psychiatric unit said one of her hardest jobs was getting her staff to understand what they had done to precipitate the patient crisis.

One of the fundamental things us naked apes need in order to stay healthy is information and the opportunity to make choices.  If doctors want to help us, that’s one place they can start.

Oh yeah—and stop dumping drugs on us for diseases we don’t have.  We’re just reacting to your rudeness.Here’s the scenario:  you arrive at your physician’s appointment five minutes ahead of schedule.  You check in with the receptionist then take a seat in the waiting room.  You catch your breath and sit quietly for a while.  Then you begin to get restive so you search through the magazines and find one that’s moderately tolerable.  Half your mind is on reading, the other half is wondering how long you’ll have to wait.

You watch the television that is tuned to CNN and wish it was something less unpleasant than the latest disaster.  News is mostly bad news, and why is your doctor hammering bad stuff into you?  Why not PBS?  And why aren’t you allowed to change the channel?

You wonder if there’s time to go downstairs and get a cup of coffee.  You don’t know, so you continue to sit.  You wish you’d brought a book of your own.  You think about the paperwork you could be doing.  You wonder how much longer this is going to take.  You check out the other people in the waiting room, trying to figure out who is waiting for which physician and how many others are waiting for your physician.  You think about making some phone calls but you’re not allowed to use your cell phone.

You’d like to ask the receptionist how much longer you’ll have to wait but she was edgy with the last person who asked so you don’t.  You need to use the bathroom but you know from experience that the door is locked between the waiting room and the rest of the suite where the restrooms are.  You’ll have to leave the waiting room and go down the hall to the public restrooms.

Finally the nurse calls you into the treatment room and checks your vital signs.  She says your blood pressure is high and asks how long it’s been that way.  You try to remember whether anybody told you what your blood pressure was the last time you went to a physician.  The nurse leaves the room—and leaves you alone to reflect on hypertension:  do you have it?  What are the consequences?  Did anybody in your family have it?  What’s the treatment?  What’s the damage if left untreated?  What’s the cost to treat?

The physician comes into the treatment room.  If he’s a bad doctor, he’ll address your hypertension and prescribe medication.  If he’s not such a bad doctor, he’ll wait seven or eight minutes, check your blood pressure again and note that it’s nearly normal.  He’ll smile somewhat condescendingly and tell you that you have “white coat” hypertension.

You ask what that is and, with a little gentle patronization, he replies that some people get anxious about seeing the doctor, that is, the big guy in the white coat.  You thank him for the explanation, while both feeling a little ashamed and suppressing some anger.  You are not a child and you’re damn well not afraid of the doctor!

One day I was reflecting on the normal human need to have a reasonable amount of control over one’s circumstances and it hit me:  there’s no such thing as “white coat” hypertension.  There is the hypertension that results from being held captive and denied all control over your situation.

The door is locked so you can’t go in.  If you go out, they may call you while you’re gone.  You can’t turn off the television or turn on your cell phone.  The human element, i.e., the receptionist, is not friendly.  And—most importantly—you have no idea how long you’ll be trapped in this situation.  Half an hour, or an hour and a half?

The reason convicted felons don’t have hypertension is because they know how long their sentence is; there’s a terminus to the time to be served.  You, however, are locked in one small room with no end in sight.  Not having any control over your circumstances is what makes you stressed and causes your blood pressure to go up.  The only reason it’s called “white coat” hypertension is because arrogant egocentric physicians think that everything that happens within a hundred yards of them is because of them.

Physicians’ waiting room hypertension is the worst type because of the staff uncooperativeness (dare we call it hostility?) but you will find it in every situation where all control is taken away from you and you are left waiting with no end in sight.  Consider, for example, the Dept. of Motor Vehicles waiting room.  Need I say more?  How stressed are you by the time they call your number and you go to the window?  What would you guess your blood pressure is?

You get the same thing in a restaurant with a line of people waiting to be seated.  They wait and wait, never knowing for how long.  Should we continue to wait?  Should we try another restaurant?  I watched it happen at a concert that didn’t start on time.  No announcement was made about the cause of the delay or how long it would last.  Can I go out for a drink?  Should I wait?  Do you want to leave?  Same thing as the doctor’s waiting room.  You’re trapped without enough information to make a decision.

My hypothesis can be confirmed very simply:  check blood pressures as soon as people arrive in the waiting room and again when they finally see the physician.  How much do they go up?  Alternatively, note the time the patient arrived, how long s/he waited, and blood pressure at the time of seeing the physician.  Height of blood pressure will correlate with length of wait.  Or write a grant, get funding, and go check blood pressures at the DMV and some restaurants.

So what’s the solution?  First, the physician could stop over-booking so she can see her patients on time.  Alternatively, she could keep the receptionist informed so that when the patient arrives, the patient can be told how long the wait will be.  All the doctor has to do to “cure” white-coat hypertension is give the patient updates every fifteen minutes, and with each update give the patient the option of continuing to wait or rescheduling.

This is not brain surgery.  This is the simple courtesy that your mother taught.  Judging from their behavior, physicians didn’t have mothers.  Your lawyer, pastor, and kid’s school teacher don’t keep you waiting more than fifteen minutes.  Why does your physician?

The director of an inpatient psychiatric unit said one of her hardest jobs was getting her staff to understand what they had done to precipitate the patient crisis.

One of the fundamental things us naked apes need in order to stay healthy is information and the opportunity to make choices.  If doctors want to help us, that’s one place they can start.

Oh yeah—and stop dumping drugs on us for diseases we don’t have.  We’re just reacting to your rudeness.

About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers. My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged. My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate. The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious. Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work. After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2
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