Anxious moments

National | Doctors worry about "white-coat hypertension," mistaken surgeries, and persuading people to exercise

Issue: "Daniel of the year 2001," Dec. 22, 2001

Test-day jitters
They call it white-coat hypertension: Some patients show high blood pressure during tests in the doctor's office but no signs elsewhere. This may just show that some people become anxious during checkups, but researchers are saying it may be a sign of heart damage. Experts estimate that about 20 percent of those diagnosed with hypertension are white-coat cases. A 1999 study found that about one-third of pregnant women gave false positives that suggest high blood pressure, resulting in some needless Caesarean sections. The American Heart Association has endorsed increased blood pressure monitoring to differentiate white-coat cases, which are usually seen as being far less dangerous than hypertension. Advanced home monitors can help detect whether a patient actually has hypertension. But Dr. Anna Grandi and her colleagues at Italy's University of Insubria said white-coat hypertension is more than a harmless case of the nerves. They used heart-imaging tests to compare white-coat patients, true hypertension cases, and people with normal blood pressure. In the first group, they found early signs of cardiovascular disease, including enlargement and thicker walls. In the Archives of Internal Medicine,they argue that white-coat cases should be taken seriously. An editorial in the journal said the study "doesn't settle the argument" but presents convincing support for treating the condition. The changes in those patients are not as serious as those with real hypertension, according to AHA spokesman Daniel W. Jones, but they show strain on the heart and indicate risk of eventual dangers, including heart attacks. "It's the strongest evidence that we have to date regarding office hypertension," he said. "Operate here"
Many operations are starting off on the wrong foot-literally. A medical oversight board last week warned of an increase in incidents in which surgeons worked on the wrong body part, or even the wrong patient. The Joint Commission on Accreditation of Healthcare Organizations calls these "wrong-site" cases. While such incidents are still very rare, the commission documented 108 wrong-site cases in the past two years, compared to only 15 in 1998. The group found that 76 percent of these cases involved the wrong body part, 13 percent the wrong patient, and 11 percent the wrong surgical procedure. Dennis O'Leary, commission president, called the increase embarrassing. "You get patients with similar names, X-rays get reversed in view boxes, people are too busy or rushed to check charts, and sooner or later something happens," he said. Dr. O'Leary said doctors could prevent accidents with such simple tasks as writing "Operate Here" on the patient's body part. He said his commission is working with the American College of Surgeons and the American Medical Association to step up surveillance of operating-room mistakes. Hospitals that do not follow safety guidelines could lose accreditation. Last month, a patient named Donald Church collected $97,000 from the University of Washington Medical Center to settle a lawsuit after a 13-inch retractor was left in his stomach. He was unable to bend over without pain and his physician discovered the device during a physical. The instrument was removed in a second surgery. A bike ride to nowhere
Most exercise programs don't work. Researchers say people don't stick to their programs and often drop out within months. "Most people who adopt exercise will quit within a short time-50 percent within 6 to 8 weeks, another 25 percent by the end of the year," sports psychologist William F. Morgan of the University of Wisconsin-Madison said. "We must be doing something wrong." Researchers, as well as many in the fitness industry, are searching for ways to make exercise easier to integrate into normal life. Mr. Morgan said much of the problem is that common exercise activities are joyless tasks that seem to accomplish nothing. Exercisers are "riding bicycles to nowhere [and] running treadmills to nowhere." Those who are able to make exercise programs work, he argues, are those who find them important to their personal well-being. Others may be better off adding more physical activities to their daily routine. "Go to the local dog pound and adopt a dog," he advised. "That's one of the best exercise machines you can find. They have to go on their daily walk."

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