By Evelyn Lawrie for the British Medical Journal (BMJ)
Evelyn Lawrie describes what it is like to live with white coat syndrome and how health professionals can help her manage this
For most people, having their blood pressure checked is a relatively straightforward process, but for me, living with white coat syndrome, it is more complicated. The syndrome feels like an uncontrollable physical or mental reaction when I am faced with medical professionals. Many people laugh when I try to explain my condition or think I am making it up, but it has caused me many challenges throughout my life.
A shock diagnosis
I had never felt anxious or worried about appointments—whether planned procedures or general check-ups; that is, until my blood pressure was checked for the first time. As soon as I was attached to the monitor my blood pressure went out of control. Initially I was given many different drugs to treat my unexplained high blood pressure but nothing helped. When my GP asked me to record my blood pressure at home for a month, the results showed that I had white coat syndrome.
I had never heard of this diagnosis before and it came as a shock. I consider myself a calm person and I have never felt worried at appointments. It was a relief to have an explanation for my blood pressure readings, but I worried about how to explain the diagnosis to health professionals and whether the condition would cause problems in the future.
Putting my diagnosis to the test
During a hospital visit for a routine procedure, my diagnosis was put to the test. As soon as the blood pressure monitor started to beep, my stomach muscles tightened. The healthcare team said I seemed to be fit and well—how was I going to explain about my high blood pressure readings? With the monitor attached and beeping uncontrollably, I blurted out my diagnosis. They saw my panic and reassured me that they would try again later.
Knowing the test was being repeated increased my worry because I knew the reading would still be high. Would the procedure be cancelled because of the high readings? I was becoming anxious. One of the team tried to reassure me, singing and dancing in front of my bed. Although it reduced my worry, the readings didn’t improve. Fortunately, as I was being prepared for the procedure my blood pressure wasn’t mentioned again and I was taken into surgery.
Reducing the worry
I still feel apprehensive about encounters with health professionals. I haven’t found anything that stops my blood pressure from increasing around them, but doing my readings at home helps. Because of my high readings I worry that procedures might be cancelled, or that I might be put on a cardiac ward. I still struggle to know how to tell health professionals the reason for my high blood pressure. The most reassuring thing for me is that the diagnosis is on my medical records. This doesn’t stop my blood pressure from increasing, but it does mean that I won’t have to initiate this difficult conversation in the future.
What health professionals need to know?
It might not be possible to reduce the blood pressure readings of a patient with white coat syndrome
Recording and acknowledging a diagnosis of white coat syndrome on medical records can help reduce patients’ anxiety
Providing distractions, such as music or small talk, for patients with white coat syndrome can help
Education in to practice
What would you do, in your practice, to support and manage a patient with white coat syndrome?
How else could you obtain a patient’s blood pressure if you suspect they have white coat syndrome?
How might you help a patient with white coat syndrome feel more comfortable during an appointment?