Leave The White Coat At The Door

There is a lot of symbolism and respect within the white coat for medical professionals. It’s a symbol of knowledge, of a lot of learning, and carries a lot of esteem and recognition. After all, medical professionals earn the right to wear the white coat, with years of study and field experience to establish their role as an expert.

It is not an easy role nor an easy pathway to reach the role of medical professional, and this should be respected. But along with the respect that the white coat should deserve comes sometimes an unwanted side effect – white coat syndrome.

What role does this play in talking to patients, and how can this be alleviated, mainly when we’re talking with vulnerable patients facing uncertainty and life-altering decisions?

While white coat syndrome is a documented medical condition resulting in increased blood pressure and hypertension, it is also responsible for raising anxiety and fear levels. Honestly, no one likes to go to the doctor, as we always fear the worst news.

This anxiety and fear can escalate and even develop to a point where a patient develops iatrophobia, a fear of medical care that can negatively impact their physical health.

Many studies are out there investigating white coat syndrome and iatrophobia. Still, the reality is that this is poorly understood, and very few solutions are presented to alleviate patient anxiety because of this. What can medical professionals do to reduce patients’ fears in medical scenarios?

Anyone who has heard me speak about twins and NICU situations, rare disease diagnosis, or engaging patients in research will know that this is my cardinal rule (and podium-thumping moment.) Please look at the patient, understand their recent history, look at the environment, and read the room. Is this a good moment to bring up the topic you’re about to talk about?

While delivering all news in a timely fashion, especially information with significant impact, it’s also vital to acknowledge that you need to choose the right moment to avoid additional stress. Read the room, and if it can wait, great. Patients/parents can take extra time to process additional information, and elevating their stress can lead to misunderstanding, mistrust, and more anxiety.

Being prepared with additional resources at the moment of delivery, be it counseling, a brochure, or even peer support networks they can reach out to. Create a moment to check in with them later, and provide additional contact information or a colleague they can contact for other questions and things they may think of after this conversation. It’s an extra point of contact that creates trust and an opportunity to gain further information.

Another consideration you may not realize is that the place you deliver news has an impact. Does this have to be delivered bedside, or can it be moved to a more comfortable environment – an office or, better, a room that isn’t associated with the clinical side? A patient lounge, even a coffee at the cafeteria, can take the patient/parent away from that clinical aspect and give them a moment to remove themselves from the surroundings to process the information differently.

By extension, consider what is happening or what could also happen around when you’re planning to meet up with the patient. Pathology results may not be the best to deliver at dinner time, and if a patient has had a surgical procedure requiring fasting, eating a meal may be their priority. The same applies to taking a shower or going to the toilet – these simple actions we take for granted may affect how a patient/parent receives news.

When we are in that space where things may not be in our control, these small steps give a sense of empowerment back to a patient. Let’s be honest; no one deals with anything well when they’re hangry or have a full bladder.

It’s probably a controversial take, but I can’t stress the importance of it. The white coat is an earned right of medical professionals, and it holds a position of respect and authority. There are moments when the white coat can reinforce your status and add an air of expertise and authority. This is absolutely vital and can also serve a powerful purpose.

But consider the situation. Taking a human rather than clinical approach can significantly impact message delivery when a patient is under stress and duress and at a vulnerable time. The white coat symbolizes that position of power, and to a patient/parent who is processing information and may feel exposed or hurting from recent events, it can feel intimidating.

An action as simple as taking off the white coat and leaving it outside the door symbolically represents taking a more human side. Removing the barrier created by that white coat can make a patient/parent feel a little more relaxed and that they are conversing with someone on their level. This, in turn, reduces their stress levels and opens communication pathways.

On the subject of communication, avoid medical jargon. Not every patient will understand medical terminology, which becomes a priority when reading the room. Education and understanding levels vary from person to person, so explain more complex terms, use illustrations and drawings to support your words, and break down the jargon. Patients/parents may not indicate when they’re having difficulty understanding what you’re saying – the reality is that they’re intimidated by the white coat and don’t want to appear (for lack of a better word) stupid. Use all available tools, routinely check for understanding, and follow up with them within a few days.

But most importantly, use the white coat wisely. It is your superhero moment, and you’ve earned the right to wear it. But also know when to use it and when it’s better to be  Clark Kent than Superman.

Everything I’ve talked about might seem like a lot to process, and naturally, changing established patterns takes time. It’s not a foolproof list; it is built on experience and observations, so please don’t think it’s a comprehensive breakdown. But here’s a list of the main points.

Is the patient recovering from a procedure? Depending on the nature of the procedure, they may be in pain, maybe still having after-effects from the anesthetic, or perhaps the parents have had a sleepless night of worry with their child’s current health battle. All these things impact how a patient/parent receives the news, so while it might be convenient for you, conversations may need to wait.

Is the patient/parent processing other information from the same appointment? Information overload is an issue related to receiving too much information at once and impairs understanding and decision-making processes. Human nature also tends to take the worst-case scenario in these situations and close our eyes to other news that may be slightly more positive.

Does the patient/parent have the capacity to process this information right now? This is tied to the previous points but also gives the patient/parent space to process the data. Stress and anxiety impact how we understand our situation and what decisions we make. If it can’t wait, ensure you set a moment to come back and check their understanding and that they know their options.

What has happened/will happen to the patient/parent in this environment in the past 24-48 hours? Be conscious of the events in this time frame and factor in the ability to process information under stress. Factor in timing around meals, procedures, etc, and consciously consider this.

What additional support could this patient/parent need after this conversation? Take a moment to anticipate needs. Do you need to call in help from a social worker or other colleague? Can you leave additional information with them to read at their own pace? Are there support networks in the form of patient organizations or internal peer-to-peer networks? Anticipating their needs will help with the burden of information.

Does this conversation need a white coat? Consider the environment, the timing,  and the type of information you’re going to give. Read the room and leave the white coat outside the door if possible.

Reducing the stress that patients/parents feel within a medical scenario can be as simple as putting yourself into their shoes, reading the room, and anticipating their needs. We know you have the best intentions; small steps can help soften the blow and improve our relationships with our care professionals.

With thanks to Monique Oude Reimer and Livy Nagy for their inspiration for this blog. Do you want to talk more about this or pick my brain? Get in touch.