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Beyond 'White Coat Syndrome'

Fear of doctors and tests can hinder preventive health care.
By
WebMD Feature
Reviewed by Louise Chang, MD

When Dorothea Lack was a little girl, she hid under a doctor's desk to avoid a vaccination. Undaunted, the doctor crawled under the desk and vaccinated her then and there. Lack said the incident provoked a fear of doctors that followed her into adulthood. "I didn't feel I could trust them," says Lack, PhD, now a psychologist who performs research on doctor-patient relations.

It's a rare soul who truly enjoys visiting the doctor. But for a significant minority of the population, fear and anxiety prevents them from getting vital care. The problem has grown in importance with medicine's increasing emphasis on preventive care. Screenings such as mammograms, colorectal exams, cholesterol checks, and digital rectal exams can save lives, but only if people are willing to submit to uncomfortable procedures well before symptoms have emerged.

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Fortunately, there are proven methods for relieving fear of doctors. But dealing with the problem first requires fessing up to it. Many people may hide their fear by saying they don't have time for a doctor's visit, says Jennifer Hay, PhD, a health psychology researcher at Memorial Sloan-Kettering Cancer Center in New York. "The first step to putting [fear] in its place is acknowledging that it's there," says Hay, who also counsels cancer patients. "Some of the most powerful fears are the ones we don't acknowledge."

Fear of a White Coat

Even if setting foot into a doctor's office doesn't feel like walking into a lion's den, your body may be priming for a threat. As much as 20 percent of the population suffers from "white coat syndrome," in which blood pressure surges when measured in the doctor's office. The syndrome produces a challenge for physicians seeking an accurate blood pressure reading. But a fear response in a health care setting is perfectly normal because most people associate hospitals and clinics with sickness and injury, says Nathan Consedine, PhD, a health psychology researcher at Long Island University.

"Fear is a response selected in evolution to promote immediate avoidance of a very salient physical threat," Consedine says. "Doctor's offices and hospitals are places where bad things happen, so it's not surprising that people avoid them." A person with white coat syndrome may not feel anxious even as her body, "at a low level, is ready to run away."

Our health care anxieties have many sources, Consedine says. We fear the prospect of a painful procedure; we're embarrassed about being naked or being touched; or we fear being criticized for unhealthy behavior. The most common fear is of a bad diagnosis, which helps to explain why as many as 40% of women who receive abnormal mammogram results do not submit to a follow-up test as recommended by a physician, Consedine says. "People just want to stick their heads in the sand."

Lack believes the American health care system tends to exacerbate these anxieties. Doctors are busier and less likely to build long-term relationships with their patients, and news stories about medical errors abound. The result is a reduction in trust in doctors and hospitals that can frighten people away from care. One of Lack's patients who suffered a bone fracture avoided a hospital because of news about the prevalence of hospital-based infections. As a result, the bone healed improperly, Lack says.

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