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Many people complain of eye problems their doctors miss during eye exams. A recent article in JAMA Ophthalmology explains the reasons why.

Cataracts and glaucoma are not the only health problems that test differently at the doctor's office. There are countless other conditions that exhibit some kind of white coat effect, the body's reaction to the presence of a doctor.

The white coat effect is named after the expectation, at least in North America, that doctors are "supposed" to wear white coats. When doctors come in to see their patients without their white coats, even if it is to minimize the transfer of microorganisms from one exam room to the next, patients are less comfortable and less confident in the doctor. 

While the white coat increases confidence in the doctor, it also increases expectation of receiving an unfavorable diagnosis.

The most famous example of the "white coat effect" is blood pressure. Most people have higher blood pressure when their pressure is measured by a doctor in a white coat. As a result, some researchers believe, doctors tend to hand out too many prescriptions for high blood pressure medicine. Other conditions that show a similar effect include:

  • Allergies. People who expect to test positive for allergens sometimes develop a reaction to the test before it is given.
  • Hearing loss. Patients who expect to be found to have hearing loss are less likely to hear tones.
  • Muscle weakness. Patients who believe they will be told they have suffered a stroke on one side of the brain may experience loss of muscle tone on one side of the body, and not necessarily the side of the body that would become weak due to the stroke they think they may have had.
  • Stomach aches. Particularly in children who are bullied by other children, the expectation of having a stomach will produce a stomach ache.

In fact, for abdominal pain, chest pain, cough, constipation, dizziness, fainting, insomnia, numbness, shortness of breath, tingling, and unexpected weight loss, the body behaves differently once you get in to see the doctor, and a physical cause cannot be found nearly 85% of the time. That doesn't mean that the correct diagnosis is "it's all in your head." Some symptoms are simply vague, and they tend to appear when they are expected. They may actually have a physical cause that the doctor cannot determine. Or they may be psychosomatic. The doctor simply cannot find out even with an investment in expensive medical tests and a great deal of the doctor's time.

Some conditions will disappear at the doctor's office under the same circumstances.

Vision problems, on the other hand, seem to display the opposite of the white coat effect.
Your vision will tend to be better at the doctor's office, especially if you go to the optometrist or ophthalmologist so often that you know the eye chart by heart. If you or a family member has any vision problem that can be corrected or controlled, ask your doctor about testing in low-light conditions that similar to the level of light encountered day by day.
Making allowance for the excellent lighting of the eye doctor's office may make the critical difference in getting needed care for cataracts and glaucoma.

  • Bhorade AM, Perlmutter MS, Wilson B, Kambarian J, Chang S, Pekmezci M, Gordon M. Differences in Vision Between Clinic and Home and the Effect of Lighting in Older Adults With and Without Glaucoma. JAMA Ophthalmol. 2013 Nov 21. doi: 10.1001/jamaophthalmol.2013.4995. [Epub ahead of print]
  • Landry M, Dornelles AC, Hayek G, Deichmann RE. Patient Preferences for Doctor Attire: The White Coat's Place in the Medical Profession. Ochsner J. 2013 Fall. 13(3):334-42.
  • Photo courtesy of Focus Clinics by Flickr :
  • Photo courtesy of Carl Bednorz by Flickr :

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