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Much More Than Simple White Coat Syndrome

Discussion in 'Hospital' started by The Good Doctor, Dec 3, 2022.

  1. The Good Doctor

    The Good Doctor Golden Member

    Aug 12, 2020
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    Ongoing consultations with a new-to-me internist have raised attention to my in-office blood pressure measurements. In preparation for my next appointment, I regularly record my BP, sometimes several times a day. In other office visits, for cancer talks and such, I simply explain I regularly home and grocery store measure my BP, which always seems to be in the established normal range. I am confident that these in-office rises are not due to my fear of the white coat nor “sanctuary trauma.”

    Moving through my sixty-fifth year, I can proudly say I remain fit and active. Also, pleased to share that when I fill out medical forms, such as for my upcoming Dupuytren’s contracture surgery, I have the pleasure of checking the no medications boxes. However, I do check the cancer boxes, as I am eight years and three curative treatment attempts into prostate cancer, and am four years post melanoma surgery. But otherwise, I am most grateful for my excellent health and fitness, offering me the capability to thoroughly enjoy my youthful grandpa days, as well as day-long hikes and bikes in the mountains, long swims, solid weight training, and even half-marathons.

    Looking back to my youth, as with many men I speak with, barring broken bones or stitches, “turn your head and cough” was our introduction to medical doctors and established clinical practice, often repeated as we went from sport to sport. Rather than triggering a fear of doctors, might those awkward visits, with the doctor lifting our testacies whilst saying turn and cough, have been a foundation for the onset of skepticism and anxieties?


    After years of prostate cancer screening, my previously missed lesion was identified by a more thorough DRE during a consultation in London, England, where I was working and living. That shock tore into my confidence in my long-established urologist back home in Texas. Additional medical experiences abroad and at home became the genesis for my little book Prostate Cancer – Sheep or Wolf? Navigating Systemic Misinformation. Sharing from the introduction section: “Reflecting back, there are several practices in England that I wish were standard protocol in the USA. I received a comprehensive letter from the doctor with each consultation, including their findings and recommendations. I no longer had to rely on what I did, did not remember, or got wrong. Also, instead of waiting for long periods in a soulless lobby, the doctors themselves came out to greet me at the scheduled time. They introduced themselves by their first name and walked me to the consulting room. No nurse conducted a totally unnecessary (at that time) check of my height, weight, body temperature, and blood pressure.”

    Adding to that reflection, not once following my medical consultations in Europe did it occur to me to seek the proverbial second opinion, common speak in the USA. And when I think deeper about the significance, I realize the urologist in Belgium who performed my prostate cancer salvage lymph node surgery and the one in France who performed my kidney stone removal surgery, which required a stent, were the only surgeons I consulted with regarding those procedures.

    Was I foolish not to seek out other opinions? I do not think so. Would I have been this confident back home? If I am honest, again, I do not think so. In the European countries where I sought medical care, there is an honest and deliberate strategy, an ethos, to disseminate best medical practices to all citizens to achieve universal parity. Contrast this to all the mixed messaging in the USA, delivered on many information platforms, highlighting the many disparities in our health care system. There is a competitive nature within American health care to earn a patient’s business.

    Traveling about Europe prior to my prostate cancer diagnosis, I did not notice the lack of medical advertising. Essentially none! When I returned home to settle on my primary treatment method and respective doctor, I realized the marketing barrage we patients face. Radio, TV, and social media advertisements, along with highway billboards, promote the fight against cancer in many ways, including claims of rank such as “a top cancer center” and “best area hospital.” And this bombardment is not limited to cancer alone. Advertisements for “best hand surgeons,” etc., inundate us as well. This illustration is from chapter five of my book, titled “Additional Consultations Back Home.” (Illustrations are a rather unique aspect of my book—one I remain pleased with.)

    Other factors that can weigh heavily on a patient are whether our medical insurance provider will cover most of the bills. Worse, we might face full denial of coverage for a procedure or medicine our doctor recommends. This raises a fair question, is the insurance provider always wrong? Also, if our doctors and treatment centers are not ranked something like “#1”, should we still have full confidence in them without any anxieties? And what a paradox pharmaceutical advertising is—empowering patients to tell our doctors what medicines we may need, just in case they do not know.

    These harsh realities do not contribute to confidence that our medical system disseminates best practices equally to all citizens, achieving parity in medical care. Although stemming from the structures and practices of our broader industrial medical complex, unfortunately, the burdens play out during the individual patient-doctor visit. How does a physician and their staff, with so little time, inspire sufficient confidence and set a trusting foundation when patients are preconditioned to question our doctors? I strive to keep all this in mind, and to relax, each time I step away from the generally unnecessary height measurement ruler and onto the weight scale, knowing my body temperature and BP measurements are next. But this is a big ask of a patient.

    As to my upcoming consultation, I am confident the internist will take the time and investigative steps to determine whether my BP is safely normal or a developing problem. I certainly do not want to feel compelled to seek other opinions, regardless of her recommendations.


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