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Anxiety & Panic Disorders Health Center

Beyond 'White Coat Syndrome'

Fear of doctors and tests can hinder preventive health care.
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Fear of a White Coat continued...

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.

Fainting Before the Needle

Although some medical procedures may make us nervous, fear of needles can evoke intense reactions. Fear of needles is a recognized phobia, listed in the American Psychiatric Association's DSM-IV manual within the category of blood-injection-injury phobia, according to a 1995 study in the Journal of Family Practice.

Needle-phobes experience panic attacks, lightheadedness, or fainting when exposed to a needle, according to the author, James G. Hamilton, MD. (Hamilton says that 80% of patients with needle phobia also report the fear in a close relative, suggesting the phobia has a genetic component.)

A 2006 study showed that 15 million adults and 5 million children reported high discomfort or phobic behavior when faced with a needle. Nearly a quarter of those 15 million adults said they refused a blood draw or recommended injection because of fear. (The study, which extrapolated from a survey of 11,460 people, was commissioned by Vyteris, Inc., a company that makes a patch, called LidoSite, designed to relieve needle pain.) Hamilton estimates that needle phobia "affects at least 10% of the population."

"Blood tests are one of the most important diagnostic tools modern medicine has at its disposal," Mark Dursztman, MD, a physician at New York Presbyterian Hospital, said in a news release announcing the study findings. Fear of needles, therefore, is "an important public health issue."

Hamilton says needle-phobic patients deserve to be recognized as suffering from an involuntary condition rather than being made to feel like "wimps" or "oddballs."

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