Comments

I don't think we can underestimate the power of psychological thought on the functionning of the human body, the so-called "psycho-somatic" effect.

Take for example syncope (fainting): this happens to a lot of people at some point in their life, and is simply a physiological response to stress. For reasons poorly understood, the body can react to certain stressors e.g. seeing blood, by causing a general vasodilation leading to a fall in blood pressure and so a decrease in blood reaching the brain. This causes you to black out and fall to the ground, where you quickly regain consciousness. There are different evolutionary theories as to why this mechanism exists, but either way passing-out in certain situations is nearly always an inappropriate response.

In the same way, if we look at the "white coat syndrome" we can see that a massive rise in blood pressure is an inappropriate response to seeing the doctor, but for some people, the part of the brain known as the limbic system (essentially a primeval part of the brain playing a role in the bodies response to stress) perceives the doctor as a potential threat and so initiates the "fight or flight" response (i.e. the sympathetic nervous system) leading to increased heart rate, constriction of the arteries, and so an increase in blood pressure.

These responses are purely reflex and take place on a sub-conscious basis, and so there is little we can do to stop the response. Therefore the only way to get an accurate reading for the patient is to remove the thing causing stress, in this case the doctor. So ambulatory monitoring seems like a reasonable way of doing this.

For those interested in knowing more, see:

http://www.ncbi.nlm.nih.gov/pubmed/9483298

http://www.springerlink.com/content/6ttcapkpm8pwat31/fulltext.pdf

http://www.springerlink.com/content/r60g85m5v2p6p21m/

23-05-10

I have thought about this problem before, since my mother's blood pressure seemed to rise dramatically when she went to see the doctor, but at home everything was fine.
I am sure that they know that the doctors don't bite,however it is possibly similar to us with our exams; we just get nervous although we know we will do fine.

Also seeing the doctor is probably not the main problem of why people gain the high blood pressure, it may be due to the work that they have got at home. For example I sometimes think about personal problems during the waiting time in the waiting room.

The only solution I see is to agree, that the ambulatory monitoring is probably the best method.

15-05-10

Would it not make sense to just keep calm? I think I can safely say doctors don't bite.

14-05-10

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