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"Some of my patients are con-
cerned with major health challenges.
They don't need additional anxiety
when they come to me for an exam
or treatment."
"Physicians can do more to make
their offices patient friendly", says
Kathryn Bordoley, an interior design-
er affiliated with Gorman's of
Southfield. "Creating visual diversion
in waiting rooms, using warm colors
in offices, and good lighting are a few
small changes that will enhance a
patient friendly environment."
Dr. Susan Zeltzer, a family physi-
cian at Providence Hospitral in

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A cuddly Teddy bear adorns a
waiting-room couch.

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Southfield, says even some of her
long-time patients still show anxiety.
"I spend a lot of time building a rela-
tionship of trust with my patients,"
says Dr. Zeltzer.
"Medical schools and residency
programs now recognize the impor-
tance for physicians to develop inter-
personal skills and are incorporating
them in their programs. Yet even
when I'm at my best, some patients
still remain anxious. I ask those
patients to monitor their blood pres-
sure at home and then we go over
what they've recorded to make sure
we get an accurate reading."
Dearborn Heights dentist Dr.
Arthur Freedman says, "Patients
requiring dental work are much less
anxious these days because dentistry
itself has changed so much in the last
10-15 years. Our drilling techniques
are much improved, people are get-
ting less cavities because of fluoride
treatments, and our mission is to save
teeth rather than pulling them.
"For the few who remain highly
apprehensive there's, always nitrous
oxide."

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The problem of white-coat hyperten-
sion comes not from the heart but
from the head. The patient's reaction
to the stress of visiting the doctor
triggers a highly agitated response and
the patients may not even realize
what's taking place.

"Just thinking about giving up the
control of your body by letting some-
one else tell you what to do will lead
to anxiety for many," says Dr. Judith
Kovach, a clinical psychologist in
Southfield. "Add to this the fear of
managed care, such as not knowing
whether you'll be referred to a special-
ist, or the insurance company may
not pay for your treatment.."
"Besides, how confident can anyone
feel, sitting in a 6 by 8 cubicle with
no clothes on? Physicians who take
the time and educate their patients
have a better chance of calming
patients, but that doesn't work for
everyone, especially when it's a quick
exam by a hurried doctor and busy
office staff. That's why many offices
take the blood pressure after a patient
has sat for a few minutes or take it a
couple of times during the same
visit.
Dr. Allan Morton, a rheumatolo-
gist, tries to relax his patients with
humor. He always prepares with the
joke of the day. "Sometimes it
works," says Dr. Morton. "Since my
practice deals with chronic diseases,
I'm likely to see patients on a regular
basis. What I've found is that after a
while, the visits become routine,
patients lose their anxiety and white-
coat syndrome is no longer a prob-
lem."
Good communication and a safe
and comfortable environment do
much to reduce white-coat hyperten-
sion. ❑

Self-Help Steps

Patients who know their blood
pressure climbs when they are at a
physician's office can do something
about it:
• Think of yourself as a partner
instead of a patient. You are just as
responsible for taking care of your
health as your physician.
• Work the system. If you hate wait-
ing in the office, make sure yours
is the first appointment in the
morning or right after lunch.
• Make a list of what you want to ask
or discuss and bring it with you.
• Bring a friend/spouse if you face a
serious health challenge.
• Ask the nurse or nurse practitioner
some of your questions. You may
get their opinion.
• Take your time before making any
major decisions. Learn your
options.
• Reduce the amount of caffeine for
that day.

