ask dr. read      Idaho Statesman columns      new articles      biography      formal resume      philosophy      services offered      contact dr. read      psychology links      other links      forms      pictures		Nice Patients Get Shortchanged by James M. Read, Ph.D. Being too nice and looking too good can be an obstacle to thorough and effective communication. At least that appears to be the case in the examining room, and it's especially true if you happen to suffer from high blood pressure. That's because people with high blood pressure, or "essential hypertension" (EH) are prone to suffering quietly. They tend to appear less distressed and anxious than normotensive patients. They present an appearance that makes physicians see them as if they are in better physical and emotional health than they actually are. As a result, doctors are less likely to talk about psychosocial issues with these EH patients. They tend to spend more time talking about biomedical matters only, missing important material that doesn't get covered. There is a large body of research that describes EH patients as more likely to suppress unpleasant emotions, be overly submissive, and have difficulty with asserting themselves. This tends to make them "nice" and submissive patients who want to act cooperatively and earn the approval of their health care provider. Unfortunately, it also makes them less likely to bring up unpleasant content that needs to be addressed. It's a problem. No matter what your condition, it's important to let your medical care provider know all the relevant details, and then some. Better to err on the side of overdoing it. Let the clinician edit what isn't needed. It's also a problem if you sound or look too good. If you are really not doing very well, it may be better to look the part. You'll get more attention from your doctor. EH patients are quite capable of assessing their own health (or lack of it) accurately. They do so just as well as those with normal blood pressure. It's the doctors and other health care providers who misjudge what is going on because the patients try to look good, behave nicely, and avoid talking about unpleasant subject matter. Doctors need to ask more of these healthy looking and reticent people. And patients need to assert themselves more. Better health care will be the result of this improved communication. Originally published in The Idaho Statesman, April 22, 1993 For more information, or to contact the author (that's me!), write to James M. Read, Ph.D., jread@jread.com