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The main symptom of the syndrome, identified for the first time in 1980, is point hypertension, that is, patients have high blood pressure in a medical setting, but under normal conditions outside the office.
Just make an appointment and the patient is already panicking. Just sit in front of the doctor to increase your blood pressure. Imagine that future exams become nervous, anxious and sweaty.
This type of reaction that some people have towards doctors, nurses, dentists and other health professionals is called: latrophobia or iatrophobia – from the Greek "iatros", which means doctor. The fear of a doctor, so. Or, as it is more commonly called, the "white mantle syndrome".
According to records from the University of California, the syndrome was identified for the first time in the early 1980s. Its main symptom is punctual hypertension, which means that patients have readings of the disease. 39, high blood pressure in a medical setting, but that the conditions are normal outside the office. .
It's hard to say how many people are suffering from this problem in the world, mainly because of underreporting, but the situation is more common than it seems. A study published by the University of Pennsylvania in the last 10 years estimates that one in five people presents the symptoms.
"It would be very important to identify patients who suffer from it," said Dr. Jordana B. Cohen, one of the researchers. "Medical phobias, including the fear of hospitals, doctors, injections or diseases, account for more than half of the phobias of patients who come to me," says British psychologist Adam Michael Cox, a clinic specializing in the treatment of patients. phobias, fears and anxieties. .
"It's a phobia of the situation, which involves a constant assessment not only of people [os médicos]but what they represent, says Cox. Many people feel insignificant or helpless in the face of authority figures. There is a feeling that doctors have the power of life and death. "
For the Brazilian psychologist Renato Belin Castellucci, a specialist in transcendental experiences, many people can make this phobia feel – and it is common for the image, even in adulthood, to be linked to an experience of the past. 39; childhood.
"Psychology helps us understand that the journey of every human being is very unique and highly individualized," he told BBC News Brazil. "In practice, this means that when we analyze the symptoms in different people, they may have a very different original emotional base in each of them."
According to him, one of the factors that can trigger white lab coat syndrome is the person who has suffered trauma during medical care. "It can be simple, like taking an injection during childhood and associating experience with pain and fear.
This unconscious response, according to the specialist, ends up being worn by the person in his memory. And associated with the elements that make up this environment: the figures of the doctor and the nurse, the furniture of a health post, the corridors of a hospital, the stretcher of the office. "It's an association of stimuli, the person ends up being conditioned and having an emotional response automatically, in the form of tachycardia, for example," he adds.
Castellucci points out that there are other possibilities. "The human mind has very complex mechanisms, and this is often not the case with medical trauma, but it's perhaps what your character represents in the imaginary of this context, a hierarchically superior social status in society, "he illustrates. "Some people create a kind of resistance to this type of hierarchy, in which case the patient passes this feeling on to the doctor, which he wants to avoid."
There is also the fact that many people have an aversion to change. And, aware of the fact that a healing and treatment process establishes medical guidelines for changing habits, resistance can be created unconsciously. "This is the reason why this syndrome often appears among drug addicts, which is a consequence, in these cases, of the fear of an orientation in favor of abandoning the type of behavior," he says.
Finally, the psychologist remembers that the cultural environment of each can be a triggering factor of the syndrome. This would be, for example, the case of a child who, still poorly understood, occurs when the grandmother is treated for a serious illness then dies in hospital. "This deeply negative experience ends up unconsciously associating the fact of going to the doctor as a negative thing, as if going to the doctor meant dying," he says.
Research
In a study conducted by Stanley S. Franklin, MD, a specialist in cardiovascular disease and a professor at the University of California at Los Angeles, the syndrome, when it is not treated, s'. is developed more rapidly in elderly patients. Research has shown that the older the patient, the greater the pressure between pressure readings in a hospital and outdoor environment.
In the study, whose results were published in 2016, 653 patients were analyzed, all with high blood pressure. They were followed for 10 years. At the end of the study, a recommendation was made that hypertensive patients, particularly the elderly and those at increased risk of cardiovascular events, should be examined more frequently and in different settings, so that the diagnosis results from multiple measurements.
The alert is corroborated by a more recent study, developed by the University of Pennsylvania in the United States and published last 10 in the medical journal Annals of Internal Medicine.
In the research, the scientists concluded that people who do not treat the syndrome are twice as likely to die of heart disease as people with normal blood pressure. In figures, the survey indicated a 36% higher risk of heart disease, 33% more risk of death and 109% risk of death from heart disease in people with this disease, compared to patients without syndrome .
At the same time, the researchers concluded what was already expected: hypertensive patients due to white lab coat syndrome are often unnecessarily treated with antihypertensives, simply by misdiagnosis. "We advise you not to treat these people excessively. [a medicação] could lead to dangerously low blood pressure outside the office and cause unnecessary side effects, "said Dr. Jordana B. Cohen, lead author of the research.
"We believe that people with hypertension in the office only need to be closely monitored to see if there is a transition between hypertension at home and in the office," she declared.
There are alternatives that can help diagnosis. Doctors at the University of Pennsylvania, for example, suggest home monitoring equipment and even portable devices that record automatic readings over a 24-hour period – so that you can compare variations with the average. environment.
In the study, Cohen points out that one of the causes of the difficulty of such protocols is that there is still skepticism about the importance of white lab coat syndrome. The doctor analyzed 27 previous studies, gathering data from 60,000 patients, to reach their conclusions. "It is clear that it is urgent to increase the monitoring of blood pressure outside the office, which is fundamental for the diagnosis of hypertension," concluded the doctor. .
At home
Another study, published in November by the University of Texas in the United States, pointed out that pressure measurements in homes are often more reliable than those done in a doctor's office or in another hospital. "Given the accumulated evidence for home blood pressure monitoring, it is time to update how hypertension treatment is usually monitored," he said.
"As the evidence for LMWH continues to accumulate, it is time to update how the quality of hypertension treatment is assessed and communicated," researchers Kevin Hwang said. and Eric Thomas, authors of the study. .
They found that 10% to 50% of patients diagnosed as hypertensive by the university hospital had normal pressure readings in a more comfortable environment. Hwang and Thomas believe that home appliances could measure the pressures – and that the data would be transmitted over the Internet to the doctor of the other.
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