WHITE COAT SYNDROME
The White Coat Syndrome is enough to make many people have second thoughts about a trip to their physician. It's often something that they fear may happen at the office or, in some cases, it's the attitude of the office staff and that's what I noticed today in a major medical center.
Despite the nice decor, I knew there were women who were practically going into panic when they came to this place. A good number of people with blood and needle phobias or just phobias about being placed into small, tightly cramped machines were trying to steel themselves to remain healthy with regular check-ups like this.
I was seated in a very attractively furnished suite waiting for a benign test that I'd had done before and for which I had no anxiety. As I sat there, I saw women of all ages coming in, some with their husbands, some alone. The women at the front desk cheerily handed them clipboards with forms on top and provided pens for completing the forms. Everything seems to be going swimmingly.
Being a half hour early for my appointment, I had a chance to look around and noticed that the large glass doors leading into the suite were painted about one-quarter of the way up with flowers and a white picket fence design that would have, in my mind, been more suited to a kindergarten classroom entrance. I really didn't like it. In a few minutes I would know why I didn't like it and something I didn't like equally as well would happen.
"Lucy," the woman called out from a side door, clipboard in hand. Lucy was a woman of about 80 who had arthritis and walked slowly as she left her husband's side to follow the woman's call. I thought to myself that this wasn't right. This woman had earned the right to be called not by her first name, but her full name. The woman calling her wasn't an acquaintance, co-worker or friend. She was someone who was going to lead her to the room where the evaluation would take place.
Within the time I sat there, each woman was called by her first name, whether she were in her 30s or her 80s. Perhaps the staff thought this, like the childish painting on the door, would create a feeling of warmth and friendliness. I didn't see either that way.
These women were coming to a place which might give them very bad news or good news, but most of them would dread the bad news and not give the good news much thought. They were anxious, but calling them by their first names, to me, didn't dispel anxiety, but created a sense of a lack of respect for them as women. They were being treated like "girls" and the painting on the door certainly gave that warning to anyone entering here. It should have taken a line from Dante Inferno where it reads "abandon all hope ye who enter here." The hope, of course, was of being treated like a respected adult. It's a component of that all-important bedside manner we hear so much about.
Bedside manner begins not at the desk or the bedside. It begins after that first step into any medical waiting room and it is first practiced by the reception staff, nurses, technicians and added to by their air of professionalism.
The next thing to which I objected, and told the technician, was her request that I sign a form which had a blank line indicating "Recommendations." I was to sign beneath this line and beneath my signature was the physician who had reviewed my form.
I told the technician that this was like signing a blank form and wasn't legally correct because there were no "recommendations" and the physician hadn't read my form. She, nicely, informed me that was the doctor wanted and I told her to tell the doctor, nicely, that this was both questionable on ethical grounds and seemed bordering on the illegal to ask me to sign a form that would have recommendations inserted later. It would appear as though I had seen the recommendations and agreed by placing my signature beneath them. Not so.
So, I signed the form and put a large arrow to the margin where I indicated "signed without recommendations on this form." Wonder how the physician will see that.
Related Topics: Personal Reporter: Answers about High Blood Pressure/White-Coat Syndrome, Making the Most of Doctor Visits
Despite the nice decor, I knew there were women who were practically going into panic when they came to this place. A good number of people with blood and needle phobias or just phobias about being placed into small, tightly cramped machines were trying to steel themselves to remain healthy with regular check-ups like this.
I was seated in a very attractively furnished suite waiting for a benign test that I'd had done before and for which I had no anxiety. As I sat there, I saw women of all ages coming in, some with their husbands, some alone. The women at the front desk cheerily handed them clipboards with forms on top and provided pens for completing the forms. Everything seems to be going swimmingly.
Being a half hour early for my appointment, I had a chance to look around and noticed that the large glass doors leading into the suite were painted about one-quarter of the way up with flowers and a white picket fence design that would have, in my mind, been more suited to a kindergarten classroom entrance. I really didn't like it. In a few minutes I would know why I didn't like it and something I didn't like equally as well would happen.
"Lucy," the woman called out from a side door, clipboard in hand. Lucy was a woman of about 80 who had arthritis and walked slowly as she left her husband's side to follow the woman's call. I thought to myself that this wasn't right. This woman had earned the right to be called not by her first name, but her full name. The woman calling her wasn't an acquaintance, co-worker or friend. She was someone who was going to lead her to the room where the evaluation would take place.
Within the time I sat there, each woman was called by her first name, whether she were in her 30s or her 80s. Perhaps the staff thought this, like the childish painting on the door, would create a feeling of warmth and friendliness. I didn't see either that way.
These women were coming to a place which might give them very bad news or good news, but most of them would dread the bad news and not give the good news much thought. They were anxious, but calling them by their first names, to me, didn't dispel anxiety, but created a sense of a lack of respect for them as women. They were being treated like "girls" and the painting on the door certainly gave that warning to anyone entering here. It should have taken a line from Dante Inferno where it reads "abandon all hope ye who enter here." The hope, of course, was of being treated like a respected adult. It's a component of that all-important bedside manner we hear so much about.
Bedside manner begins not at the desk or the bedside. It begins after that first step into any medical waiting room and it is first practiced by the reception staff, nurses, technicians and added to by their air of professionalism.
The next thing to which I objected, and told the technician, was her request that I sign a form which had a blank line indicating "Recommendations." I was to sign beneath this line and beneath my signature was the physician who had reviewed my form.
I told the technician that this was like signing a blank form and wasn't legally correct because there were no "recommendations" and the physician hadn't read my form. She, nicely, informed me that was the doctor wanted and I told her to tell the doctor, nicely, that this was both questionable on ethical grounds and seemed bordering on the illegal to ask me to sign a form that would have recommendations inserted later. It would appear as though I had seen the recommendations and agreed by placing my signature beneath them. Not so.
So, I signed the form and put a large arrow to the margin where I indicated "signed without recommendations on this form." Wonder how the physician will see that.
Related Topics: Personal Reporter: Answers about High Blood Pressure/White-Coat Syndrome, Making the Most of Doctor Visits
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9 Comments:
Dr. Farrell,
I agree with you. I don't care for being address according to my marital status, which is single and makes others want to use "Ms." which I detest. I am not my marital status! I am me.
I don't mind when they use my first name as long as they also use my last name. I'm NOT their friend. They don't know me that way and I resent the out of place over-friendliness. Even my regular doctor's staff, who sees me more often than I wish was necessary, should use my first and last name and I am lucky that they do. That does make me feel respected and valued rather than feeling being condescended to and as if they are doing me a favor to see me.
Professionalism, confidence, and feeling taken care of is what is reassuring when I am feeling anxious about medical tests or treatments. I think when a health care worker is trying to be reassuring and caring they tend to resort to the first name usage as if they are taking care of a child. They may be taking care of the child within us that is anxious or frightened, but they need to be addressing the adult that we are.
Thanks again for a great blog.
~Tasker
Tasker, you are an appreciated responder to my blogs.
I really do see that it is a matter of respect and that's part of any interaction be it with a professional or someone else. Until they give you permission to call them by their first name, I was taught, you don't do it.
Thanks, again.
Dr. Farrell,
I want to send copies of your post to each of the five medical offices I have been to in the last month, where I have been invariably been summoned from the waiting room by my first name (and it has been mispronounced twice). I feel exactly the same way about a stranger addressing me by my first name: this artificial familiarity makes me extremely uncomfortable, and the lack of professionalism makes me wonder what else in the office is being done in a shoddy or casual way.
It's nice to know I am not the only one who is bothered by this unfortunate trend!
I think this is something that needs consideration by anyone who's doing all that office staff training the professional journals talk about.
The rule should be, "Wait before you call anyone by their first name." I taught my medical students to ask the patient what they would prefer to be called and I still believe that's true.
Thanks for your post.
I realized having obsessive compulsive disorder (OCD)_thoughts, behavior as well as anxiety (severe, unusual)when I was only eight years old. I went under medication in 1988 when I was 21 after experiencing a very severe panic attack. Since then docs have prescribed many antidepressant on me but panic attack returned every 2 or 3 years. Since I've been given sertraline 7 years ago it hasn't reappeared (along with vigorous physical exercise too)though way of life have become less complicated to me since then unwanted obsessive thoughts and anxiety occurs from time to time.
could there be any way to improve?
As a former Administrator of a psychiatric/psychological clinic, I am gruesomely aware of HIPAA, a federal regulation that places many restrictions on the release of ANYTHING relative to your patient relationship at any clinic. So, being "called out" by your first name is a protective measure to not reveal your identity to all in presence. I find it appropriate and in accordance with federal law (HIPAA).
Hank Biggs, MBA
I agree with Hank. I work at an ob/gyn office and of course we see most of our patients very regularly. Our patients like it when we call them by their first name and do act like a friend. It doesn't make them uncomfortable. Many of them tell us that they like the fact that they are not just "a patient" to us. We get to know them, and what's going on with them, and know what's going on with them without a chart or them refreshing our memory. They come in and we know their name and even when they have follow up appointments we know alot of their schedules and know what time they need appointments, if they need work excuses, etc. And this isn't a small doctors office either - their are 5 doctors, plus (on the average) 35 ob patients a day. Even most of our patients bring the babies in for us to see when they deliver because we have made a 'relationship' with them. And, personally, that is what I would like. I want them to know my name and act like a friend, not like I am just some stranger that is there for some test and no one cares what happens to me or with my health.
Working on the other side of the fence, ihave to say it is hard to manatain patient confidentiality if both the first & last names are blurted out to call a patient from the waiting room. And using a number or other system isn't very applicable either. I appreciate that some patients do not like being called by their first names but it is the easiest & safest way for a patient that might want to remain confidential, remain so.
I agree somewhat...I don't mind anyone being casual by saluting me me by my first name, but one must then expect the same in return. If it's Dr. John Smith, I then feel just as comfortable addressing him as John...same with nurses and staffers. If someone uses my first name and they have a nametag that only lists their first initial and last name, I'll just use their first initial.
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