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White Coat Hypertension

Your patient is sitting in a room.

That room is, of course, in your office, pharmacy, clinic or hospital. It’s most likely very plain — at most, the walls covered with some posters depicting various parts of human anatomy and information about how to wash your hands properly to avoid illness. We rarely think about it, but this is not a comforting space. Your patient is sitting in an unfamiliar room and is waiting for someone to waltz in with declarative information about what is wrong with his or her body.

When we, as health care professionals, imagine this scenario, we do not see ourselves as the bearers of bad news. We’re the helpers — the ones who can fix the problem. However, it’s important to remember that this is not how we’re always seen. When patients see a white coat, their mind does not jump to happy thoughts. A white coat means someone is sick.

A very simple but interesting phenomenon in health care is the concept of “white coat hypertension.” Initially, if you take a patient’s blood pressure, it may be abnormally high. This is simply because they’re nervous about the situation. If you just wait a few minutes and then take the patient’s blood pressure again, it has often decreased a fair amount. It’s a simple enough concept — the patient is worried that something is wrong and this makes their blood pressure increase. However, this leads me to the question: why do we make our patients so easily nervous? That is not our place in the health care equation.

As a pharmacy student, I spend a large amount of time learning how to connect with my patients. In fact, my university requires us to take an entire course dedicated to practicing clinical situations with actors weekly. Our professors provide us with feedback about our therapeutic decisions and ways they think we could make the patient feel more comfortable, but the actors also tell us how we made them feel as a patient. It’s an incredibly eye-opening experience, and one that made me truly realize how much of our actions affect our patient’s perspective. I will never forget one actor talking about how important it was to incorporate positivity into the encounter, saying, “You never expect good news from a white coat.”

In school and on clinical rotations, our professors and pharmacists focus heavily on patient care. However, in the real world, maintaining this focus is not quite so easy. A pharmacist is often juggling several jobs at once: checking prescriptions to ensure they are correct, scouring patient profiles for drug interactions, communicating with doctors about possible and necessary changes in a patient’s medication regiment, counseling patients and providing vaccinations, in addition to many other clinical and administrative duties. The extra minutes required with each patient to make them feel comfortable are often nonexistent in a pharmacist’s day.

Though extra minutes in our work day are few and far between, we can’t forget that they are just as important as the minutes we take to ensure that medication therapy is clinically correct. We may be the ones with the medical knowledge, but that doesn’t mean the patient doesn’t have a lot to offer to the conversation as well. After all, this is their health, their life. We can’t just alter it with no explanation and expect things to pan out well. Patients want to know that we genuinely care about their well-being, as opposed to just being there to give out treatment plans to everyone with a disease. Health care professionals are extremely busy people, but all of our studying and knowledge means nothing if we can’t help the patient improve their health and life.

So, how do we become the white coat that people look forward to seeing? It’s as simple as remembering that they are, in fact, people. They have their own job, family and friends. We should be interested in that. We should want to know our patients as people, and we should want to care for them as such. That’s the first step.

In addition, we also have to remember that we are people, too. There was a time when we didn’t know what the words hypertension or anticoagulation meant, and someone had to explain it to us. It was explained to us because it was becoming a part of our lives. Now it’s becoming a part of your patient’s life, too. Ensuring that the patient fully understands his or her diagnosis and medication and knows how to incorporate it into daily life will lead to a much more successful treatment plan.

A few weeks ago, the dean of my school of pharmacy stood on stage during our white coat ceremony and declared my class as ready to embark on the final steps towards earning our degree and receiving the privilege of treating patients. He focused on that point — that it is a privilege to be a health care worker, not a right. We have been given the opportunity to help others.

When we take steps to make our patients feel comfortable, we become more than the white coat. Remember starting school with those grand plans to help people? This is how we accomplish that. When we truly take steps to care, we become someone that the patient no longer dreads seeing. We become the helpers.

Therese Castrogiovanni Therese Castrogiovanni (1 Posts)

Guest Writer

University of Kansas School of Pharmacy

P3 student at the University of Kansas School of Pharmacy.