It is not uncommon to feel somewhat uneasy in a doctor’s office. Colloquially, we refer to this as “white coat syndrome,” and it is experienced by many patients. After all, medical settings are clinical and often less than inviting. Many people experience feelings of anxiety as they await a doctor, sit in an examination room, receive a shot, or undergo a physical check-up. But, for some people, this relatively common uneasiness can escalate to overwhelming fear. If a doctor’s office is a place where we go to care for our health, why then do some people begin to view these settings as places of terror?

The answer is best viewed through a lens of anxiety. In an anxious state, we misinterpret benign situations as threatening ones. Here are some common anxious thoughts that patients experience related to medical care:

• I will receive catastrophic news about my health.
• The doctor may miss something important and give me a clean bill of health when, actually, there is something wrong.
• The doctor knows something catastrophic about my health that they are not telling me.

In a heightened state, we may anxiously question our health status even if we are given a “clean bill of health.” This anxious thinking typically results in two different behavioral responses:

Care-Seeking: The care-seeking patient will, quite literally, seek out medical care, often in the form of unnecessary doctor’s visits, blood tests, scans, and visits to various specialists. While it is a positive thing to be on top of one’s health, the care-seeking individual takes this attention to the extreme, escalating it to hypervigilance and fixation. Further, care-seeking responses can become costly as patients expand their circle of care to include out-of-network and self-pay providers, emergency and hospital visits, and unneeded medical expenses.

Care-Avoidance: This is the opposite of care-seeking behavior, wherein a patient becomes completely averse to medical treatment. In this resigned state, the patient forgoes regular treatment out of fear of something negative being detected. The danger, ironically, is that this avoidance may lead to underlying medical issues going undetected and untreated.

How can you tell if you are experiencing plain old “white coat syndrome” or a more intense anxiety response? First and foremost, we need to pay attention to our behavioral response. A care-seeking response might look like moving a scheduled appointment to a sooner date, visiting a different doctor in advance of the appointment to quell anxiety, or scheduling additional appointments or unprescribed tests to supplement the physical. All of these can be viewed as over-responses. A care-avoidant response might look like cancelling the appointment or delaying recommended medical treatment. An adaptive, or healthy, response might look like feeling anxious without taking any urgent action, following through with the appointment as scheduled, and following any guidance received at the appointment.

All behavioral responses are reactions to situations and stimulus, and behavioral responses to medical treatment are no different. Left unchecked, these fear-based responses can quickly escalate to full-blown illness anxiety. Awareness of our responses, understanding of care-seeking and care-avoidant behavior, and acknowledgment of our own unique way of responding is our path to ensuring a healthy reaction to a sometimes frightening part of living in a human body.

The simplest question to ask yourself if you are feeling anxious about your physical health is, “Does this feeling require immediate action?” When we stop before we react, we create space for clear decision-making and a true, unbiased view of the situation that does not result in a behavioral response on either side of the extremes.