White Coats Freak me Out.

January 22, 2012 10:14 AM

Anyone have tips to control white coat syndrome?

I was getting a physical done a few days ago and my initial blood pressure reading was 180/90 (yikes!). The nurse then immediately retook it and it fell to 150/80 then a 3rd time after a few minutes it fell further to 138/78. I ended up having my blood pressure taken about 9 times at the physical just to make sure that I'm really not hypertensive, but every time the 1st reading was off the charts and the subsequent ones are lower. This physical was particularly stressful for me since I knew that I could be disqualified from the Army if something went wrong.

I've had this happen to me a few times before in a doctor's office. Every time it's happened, I've known that I needed to get blood drawn and even though I'm not afraid to needles, I'm still not too keen on them. Whenever I'm at a doctor's office if I'm just suffering from cold or other minor illness, my blood pressure's fine, usually around 110/70.

I'm otherwise a healthy 5'7", 156lb female who runs and lifts weights regularly. I eat pretty well too.

Is there any way to control white coat syndrome or is it just something I get used to?

posted by astapasta24 to Health & Fitness (11 answers total)

This happens to me all the time too. I grew up in a family of white coats and I'm not scared of needles. This also happens to my mom and she's one of the white coats.

For me it's just something I tell my docs. They're pretty used to it too.
posted by saffronwoman at 10:27 AM on January 22, 2012

You might want to monitor your blood pressure outside the doctor's office, at those automatic machines they have at pharmacies. They also sell pretty inexpensive automatic blood pressure cuffs, if you'd prefer to check your blood pressure every day at home. This will either reassure you that your BP is actually okay (which relieves some of the anxiety at the doctor's office) or demonstrate that it's not white-coat hypertension, it's hypertensive hypertension. :)

I also found meditation helpful. When they put the cuff on, my mind is clear, and I'm concentrating on the breath, the physical sensation of the tightness of the cuff, etc.

Another important thing is to not put so much pressure on yourself to have low blood pressure! For many people, weight control, diet and exercise can control hypertension, but sometimes it's your genes, and even if you're doing all the right things lifestyle-wise, the only thing that's going to get you below 120/80 is taking a pill every day (which is not the end of the world.)
posted by BrashTech at 10:32 AM on January 22, 2012

In recent years I've had a similar problem - my blood pressure would read a bit high at the beginning of my doctor's appointment, but then after consulting and chatting and going over my chart he'd take another reading and it was back in the "normal" zone. He suggested "white coat syndrome" but quite frankly I've been going to doctors for so long they really don't frighten me, nor do needles or other torture devices they produce from those many-drawered cabinets. I think, and I could be wrong, that the reason my BP is up when I first arrive is that for the past five years or so Mr. Adams has driven me to my appointments, and while he is the most patient man in the world in most cases, put him behind the wheel and he suddenly yells at every driver who dares to pull in front of him, drivers who are going too slow, etc etc. In short, I tend to get very nerved up during the drive to the office. (I get similarly stressed during other drives, but those are usually to a place where no one is going to check my blood pressure.) My doctor suggested that I purchase a home blood pressure kit and to test myself daily at different times and record the results. He gave me a chart that showed the "normal" range and told me that if I recorded a reading in that zone more than three times to immediately call for an appointment. Well, in the comfort of my own home sitting at the kitchen table my BP has remained in the normal zone every time I've taken it.

So I don't have any tips for relaxing yourself at the doctor's office, but perhaps taking your pressure at home and keeping a chart will set your doctor's mind at ease regarding your actual usual pressure.
posted by Oriole Adams at 10:33 AM on January 22, 2012

Best answer: Serious white coat syndrome here. I have my blood pressure taken at the start of the appointment (often at their insistence), and always again at the end (at my insistence, including recording this result in my records). If you're concerned with an accurate reading, it's also important that they use the right size cuff; using one too small will give a false positive for high pressure. I also have my blood pressure checked outside of a medical environment, and I second that idea strongly.
posted by vers at 10:39 AM on January 22, 2012

Sitting with both feet planted firmly on the floor helps get an accurate read. Crossing your legs can throw it off a bit. My suggestion is to focus on that. Tell yourself that you want them to get the most accurate read possible. Go Zen, focus on your breathing, the position of your body.

My son is terrified of shots. He gets very pale and nearly passes out. The wait before the shot can be agonizing for him. Talking about something else doesn't work. I get him to focus on how he is feeling. I ask him to pay attention to how the top of his head feels all the way down to his toes. It really helps him to focus on one small thing at a time.
posted by myselfasme at 11:07 AM on January 22, 2012

Usually taking BP is one of the first things that happen when you appear at the clinic, just be an advocate for yourself and say hey! I know from experience my BP is ALWAYS wonky when taken first thing. Let's do the rest of the physical/whatever first and then take the BP.
posted by ilikecookies at 11:31 AM on January 22, 2012

I have this to the max, and it doesn't typically fall very much during the appointment. My doctor had me get a digital cuff and take morning and night readings for a few weeks at home. Those were basically fine. I'd discuss something like that with your doctor, so that there further proof in your medical records that your BP is basically fine.
posted by mostlymartha at 11:38 AM on January 22, 2012

Best answer: If your BP reading is high, ask them to check it again at the end of the visit, or at the very least wait several minutes before trying again. Doing a second (third, fourth....ninth!) check right away will give inaccurate readings, not to mention increasing your stress.

Seconding that the size of the cuff matters, and I recently learned that a too-large cuff will also give inaccurate readings. If the standard cuff doesn't fit your upper arm correctly you might want to invest in one of your own that you bring to medical visits.

Also, if the 110/70 readings are at the same medical office, it should be obvious that this is an unusual spike. Similar to what Oriole Adams said, I've been told that physicians don't usually become concerned about chronic hypertension until a patient has had high BP readings on three consecutive visits.
posted by camyram at 11:40 AM on January 22, 2012

Would it help to have someone go to the doctor with you? They could have the job of advocating that your blood pressure is taken at the end of the visit, so that you don't have to be worry about that.
posted by lab.beetle at 1:37 PM on January 22, 2012

Best answer: I have the exact same issue, and it led to getting my blood pressure taken 5 times in one visit, and of course I got more and more anxious as the nurse and nurse practitioner kept taking it again and again. Vicious cycle! What I've done to try to combat it is to focus on my breathing and an image (usually the ocean) or sometimes I mentally recite a favorite poem. Basically anything to keep me from thinking about my blood pressure being taken.

Also, it's always good to let the doctor or nurse know that you know you have an issue with white coat syndrome. If at all possible, keep track of your own blood pressure in the week or so before an appointment, and take the log to your doctor when you get to the appointment. I know my blood pressure was back in normal range when I had someone take it outside of a doctor's office while I was doing something else like reading or watching TV
posted by yasaman at 3:13 PM on January 22, 2012

Definitely let the doc/nurse know up-front that you suffer from white-coat syndrome.

I overcame it by going to various doctors a lot.

I now have enough medical issues that I'm often at one doctor's office or another. While that worked for me, I can't advise you to gain a chronic illness or two. :)
posted by deborah at 11:30 PM on January 23, 2012