Saturday, November 14, 2009

WHITE COAT HYPERTENSION

You’re probably familiar with the term “white coat hypertension,” an abnormal rise in a patient’s blood pressure that occurs only when a nurse or doctor pumps up the cuff. That is, it’s nervousness due to medical presence.

But have you considered the reciprocal phenomenon, physicians getting anxious around patients? They do, you know. I don’t think their blood pressure rises, but they rapidly shift their persona, the self they exhibit, from standard human being to scientist—the upright, knowledgeable, competent, confident, objective physician.

Well, shouldn’t the doctor be a scientist? After all, that’s been our ideal during the past century, and a sensible choice it’s been, given that our greatest medical advances have been scientific. We justifiably think so highly of science that it’s arguably our secular culture’s religion, and the physician its priest. My parents’ generation took the word of doctors as gospel. If, when I was a child, my doctor had recommended sewing my elbows together, my mother would have acceded enthusiastically.

But only half of medicine is science. As our professional elders universally advised, it’s a science and an art. That maxim always sounds grand, but the fact is that docs aren’t taught the art, only the science.

I’m not even sure the art can be taught as much as modeled, and that requires intent, time and experience. Until we develop it in ourselves, an entire profile of sick people remains invisible to us. We don’t appreciate, and so can’t treat, their suffering. We comprehend them instead as intellectual challenges, disordered physiologies begging resolution. That’s when we act as technicians rather than healers.

I know physicians who do both. That feat is tangibly therapeutic for their patients, but even more so for them. Think about it: how would you manage wading in suffering for a living? Imagine having some responsibility to guide people through hyperemotional life-and-death situations at least forty hours weekly. What would you do with the suffering you can’t help but absorb?

Not long ago I witnessed an encounter between a young woman with severe rheumatoid arthritis and her physician, whom I know personally as a gentle, loving human being. Describing her pain, the patient cried. I watched the doctor. If I could see the thought balloon over his head, it was something like this:

My God, this poor young woman is suffering something awful; I want to get up and just hold her; on the other hand, that’s not very professional.

He literally wrung his hands, as though his left and right sides were struggling with one another. In the end, he stayed put, resumed a straight face and wrote her a prescription for a more potent painkiller.

Afterward, I couldn’t help but ask the doctor how he felt. He said, “Ripped in half.”

Good, I thought: the beginning of a conversation. “Ripped in half? Can you tell me more about that?”

“No,” he answered. “I don’t want to talk about it now. I have more people to see.”

This suffering that’s part of the medical stock-in-trade continues to inhabit us like a slowly growing abscess. Without periodic, conscious draining, it’s not healthy. Look up physicians’ rates of divorce, drug dependence, alcoholism, and suicide. Our health statistics don’t amount to a great advertisement for the exclusively scientific medical style.

So when you notice your doc’s caught a case of white coat hypertension, please understand what’s likely on his or her shoulders. Treat him or her by insisting on humanity along with science in the examining room. You might ask, “How are you doing today, doctor?” Believe me, you’ll be thanked.

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