White Coat Syndrome

Today I worked another 12 hour shift and learned the definition of "white coat syndrome." I'd heard of this phenomenon that goes hand in hand with "black and white fever," but never witnessed it first hand.

I had a young male patient today who was scheduled for surgery ...let's call him Mike. He was a very sweet, cooperative guy who didn't want to cause any trouble or inconveniences for us, even if it meant his personal discomfort. I noticed that his blood pressure ran a bit high, not something you want to see in someone about to head down to surgery. The doc came in and assessed him, prescribed him a drug to lower his BP and instructed us to send him down to surgery. When we got him back he was on continuous pulse and oxygen saturation monitoring. His blood pressure was still above normal, but not as bad as it had been...chalk it up to pain. But his pulse was sky high! Why??? We didn't notice any bleeding and the EKG showed a normal, but fast heart rhythm. I later came back to check on him, multiple times, and always knocked on the door to announce myself. When I came in with an IV medication in a syringe, his pulse went even higher.

I decided to do a little experiment. His pulse/oxygen machine shows his continuous heart rate, so I started to peak into the room without announcing myself, and before he noticed me, his pulse was fully 40 beats per minute lower! This guy had a horrid case of White Coat Syndrome. I'd never seen it this bad...he was terrified of us!

I'm not sure if there's anything that can be done for it...most people don't even realize they have it. But at least it's nice to know there wasn't anything seriously wrong with Mike...he just didn't like white coats, just like some of us don't like seeing police cars. :)