Before responding to this post, please note that participation in this subreddit is reserved exclusively for actual residents of Japan. If you are not currently residing in Japan (including former residents, individuals awaiting residency, or periodic visitors), please refrain from commenting.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

In your country the doctors write a lower BP and HR than the reading? What?

Most doctors I've had, if a high number came back would first:
a) Ask me to take a few breaths, relax, and try again
b) Ask me what it was if I measured at home.

They'd still write whatever number they got, but wouldn't do anything if I regularly had a lower blood pressure.

On the one hand, it sounds like you might want a better clinic, but on the other hand, you're lucky you get seen immediately after arriving. I usually sit around for 20-45 minutes before my blood pressure gets taken, right before I go in to see the doctor.

I've lived and worked in about eight countries around the world, and unfortunately, I suffer from a health condition, which requires ongoing medical treatment. This together with other medical concerns that I've had over the last few decades; I can say has been treated really well in countries in North America, Europe, and Africa. Here in Japan, I've had some good treatment, but also some extremely bad treatment here. Doctors screwing up medical diagnosis, screwing up surgical procedures, and not even knowing the side effects of the medication that they prescribe for me. But also some extremely horrendous personal behaviors that one could say are sadistic in nature. So for me in all the countries I've traveled to, Japanese doctors are definitely the worst and most unprofessional generally speaking. And unfortunately, there doesn't seem to be any way to warn the rest of the public about some of the terrible doctors I've had horrendous experiences with. Japan loves to keep its privacy, even for doctors that should never be doctors.

Yeah this was the fucking bane of my existence during pregnancy. I would always arrive at the station 20 minutes early, do like deep breathing to try to calm down and then go to the clinic to get measured, but again just purely due to being worried about being at the clinic, my numbers were always higher. In the end I had to tell them it was because I was anxious and to let me measure at home, because when I did my bp is always normal.

They did, and my numbers from the monitor at home were always totally fine, but I remember being surprised that they also seemed unaware that just being at the clinic can be very stressful.

yeah whenever i go to get my company health check, whenever they check my heart rate, they always write “borderline abnormal” on my chart lol

i stopped walking to the clinic and instead take the subway just to avoid the elevated heart rate

They are. 白衣高血圧is known here.

I worked a 救急救命士 before so I might be able to give a little insight.

It’s one thing to request second readings and add context. It’s another to critique to almost scolding.

I’m not sure how you made it come across but being direct in calling something a doctor does as a syndrome is basically fairly rude, especially when you yourself don’t work in healthcare and the word is different in Japanese.

Perhaps a better way may have been to hint about how “I heard online it can be common for doctors to…”

You didn’t actually mention how high your BP was so depending on what it was, I may also freak out as well and consider further measures. If it’s typical “elevated” then a note on the side can be added by anyone taking vitals. But I imagine that if you’ve lived here for any decent amount of time then you probably shouldn’t have astonishingly high vitals.

Based on the information, or lack thereof, I think your doctor possibly was rightfully concerned without much context. His lack of context and willingness to jump the gun is a mistake but your health may be in question as well. I am almost certain your presentation of white coat syndrome came across as rude.

Considering you have an experience with a doctor and make a blanket statement about “I wonder what other reasons they mess up”, I think the lack of humility of not working in healthcare is precisely why you didn’t get the reaction you’re looking for.

This is crazy because I just went to the doctor and the nurse who was a very nice older Filipina basically checked my BP, told me to take some deep breathes with her, and to relax, then took it again and wrote it down. Seems fairly basic and common sense a BP reading from right when entering versus resting BP should be considered. I'm not surprised

I didn't know about this, but a doctor in Japan told me! I had the same problem, get to the clinic, measure myself, slightly high blood pressure. But one doctor told me that it's normal, since I just arrived, and lo and behold the next time I took one on arrival, and then another after 10 mins on the waiting room, BAM totally different, much lower. That same doctor also told me it's normal to consider that measuring at the doctor adds around "10 points" of blood pressure, so I was "normal".

If anything I had the opposite. I Googled my BP and it said like, "Call an ambulance immediately". But expressing concern to my doctor, they were just like, "Meh, I'm sure it's fine--your body gets used to it."

I have never had the doctor see me so quickly after arrival. Usually I have to take a number and sit and wait.

The BP machine is "self server" though at any place I have been to in recent memory. If I take it right when I arrive, some reading might be higher, but by the time I wait for my turn with the doctor, if I have not had enough time to relax it means my resting stats are too high.

I had similar a few years ago after an injury. Hurting, some breathing difficulties, im terrified of clinics and hospitals - took me 4 days to be brave enough to even go. Also summer so hot.
Took blood pressure, had a very strange look on face, got someone else to do it, same reaction, got a 2nd machine, same reading.

Told it was so high i should be in hospital. (Its usually slightly on the low side of normal as a baseline).

Eventually told them to ignore it and just look at what it come for and they did, After doing that BP was normal when checked before leaving.

I hate doctors/clinics/medical anything so try to go out of my way to avoid going near one unless its mandatory. That experience didn't encourage me to go back for anything unless i can help it.

That said, even in the UK the first thing they do in a GP or hospital is slap a BP monitor on so its always going to be through the roof there too.

I can relate , I have the white coat syndrome to the point my dr gave me a monitor to use at home a day or so before going into see her

Perfectly fine at home , super elevated at the clinic

You need a new clinician. I worked in medical editing here for almost 20 years, revising thousands of papers by Japanese doctors and scientists—they absolutely know about white coat syndrome.

My issue is that at my annual checkup they have the bp machine really low down on this tiny in a corner where I have to crouch down in this bizarre position while it measures. Clearly nothing like the good posture the instructions indicate.

While I think the idea of the annual health check is great, it feels like a lot of its value is reduced as it’s handled like a factory where they just go through a checklist of things they’re meant to do, then at the doctor at the end if you do ask them something they’ll be “oh you should talk to someone about that”.

Not from/living in Japan but I was trained professionally as a pharmacist in the US and white coat syndrome is something they hammered into us at school, your POV is correct and completely understandable (except the recording a lower number than measured thing that's weird).

My medical care in Japan has been outstanding. When I first came to Japan, I always joked about getting on a plane and going back to Canada if ever I got ill. Well, illness, and regular maintenance happens. I’m fortunate to have found a doctor(s) I really like. They are, by the way, aware of ‘white coat syndrome’.

During my pregnancies everytime I got a borderline high BP reading they didn’t freak out and sent me off to have a c section. They told me to wait and rest for several minutes before taking another reading.

You’re judging a whole country’s medical system from one single experience.

The readings I get when I go to renew my prescription every month for my blood pressure medicine are always much higher than when I check at home. I told my doctor that the clinic environment is too noisy and busy for me to be able to relax. My doctor goes by the readings I take at home and record in my blood pressure diary.

I laugh at how often these subs complain about Japan’s medical system without taking into account Japanese lifespans.  Do posters assume the plethora of elderly is in spite of the medical system? The dismissal of years of study and experience for widespread conclusions based on poster’s individual experience seems symptomatic to the “death of expertise.” 

I have high blood pressure. My doctor always takes my blood pressure and then says "it's a little high, but everyone tends to be higher at the doctor's office." He also insisted that I buy a sphygmomanometer and take my blood pressure at home...

Not me.

All my doctors and nurses always tell me to take long, slow breaths and relax for a minute before they check my BP.

I experienced this too. I had just biked there, in a rush after work and immediately had my blood pressure taken. It wasn’t alarmingly high or anything, but higher than my normal. I was just getting a birth control pill renewal.

I think I may have white coat syndrome like my mom. When I go to clinics, if my bp and heart rate are crazy, I don't necessarily tell them I have "white coat syndrome" but just tell the nurse I'm anxious when I'm in clinics (少しドキドキしてます) and they allow me to go for another reading which is always lower. My blood pressure is always normal when I measure at home. I think the word for white hlcoat syndrome is 白衣高血圧

I had an unusually high BP reading and the doctor specifically said that it’s probably because of stress of being at the hospital and that we should try again at the end of the appointment. He didn’t use the expression “white coat syndrome” but it’s certainly not unknown here.

Last time mine was way too high, the nurse told me to sit down and that they’d take it again in 5min. Maybe it was your clinic that is weird?

Never heard even home of a doctor writing a fake number to account for your situation. Especially if you have hypertension that would invalidate a lot of things…

Writing a lower number instead of waiting and remeasuring is just wrong though.

I arrive early and sit for like 10 min before measuring (they have the machine in the waiting room, for you to use when you calm down lol). The machine even says yo chill for ~15 min before using.

The only reason you're probably complaining here is that the readings are high and you feel you are healthier and deserve some sort of better number.

You know, it's really cheap and easy to measure this stuff at home yourself if you think that'll make a difference.

The science behind it is a little complicated. The position you're in, including the way you have your arm can influence the figures. The main thing is to do it consistently.

For the vast majority of people, they wouldn't have high reading even when measured immediately, that's why they do it. I have fast heartbeat after walking fast to clinic, but never high blood pressure reading. I assume that's the case for most people.

Coming to the clinic in time so that you can catch your breath is on you, not on them. 

Write a blood pressure diary and there will be less questions. Some tonometers even have a function to connect to an app and log everything automatically.

Whats your bmi

My clinic always tells me to take my BP after having a short rest. If it’s higher than usual they ask if I was in a hurry or something and measure it again later.

My husband’s bp has always been abnormally low so he actually consciously makes it go up before measuring it because the conversation is a hassle lol

In my case, if the measurement is too high, they ask you to relax and try again in five minutes. They are well aware of white syndrome.

What kind of clinics are you going to where you don't get at least a 10-minute wait in the waiting room after the appointment time before being seen by the doctor? Are you on some kind of corporate insurance that gives you priority doctor access?

I’m fortunate to not have high blood pressure and have never had a high reading even when just arriving, so I’ve never had a similar experience to the OP, but I wonder how many of the negative experiences are down to language and communication issues vs genuinely poor service (which I’m sure does exist in certain cases).

I have no idea of the Japanese language ability of the posters here, but a general observation I have is that Japanese people in general are more likely to come across as terse, rude and dismissive when speaking in English (due to lack of ability to phrase English politely), or seem awkward to a foreigner who doesn’t follow the normal rhythm of conversation in Japanese.

I was fortunate to learn Japanese from the age of 14 (I’m now 38) and have very rarely had major issues with doctors, at least when it comes to relatively routine inquiries (I can’t speak to those with complex or chronic illnesses). I’m a bit of a hypochondriac, so I’ve visited many, many clinics, and the “worst”I’ve had from doctors is those who make no effort to hide that they’re in a hurry and chuck medicine at me after minimal conversation, or certain rude/passive aggressive receptionists.

That said, when accompanying my husband to appointments to deal with his ADHD, I have remarked on the extremely poor standard of care for mental health, where mental health care seems to be limited to base level psychiatry and chucking medication at the problem to make it go away.

My go to doctor here in Japan is Japanese but did further studies in the US maybe that's why he knows about the white coat syndrome.

I use this one at home: https://kakaku.com/item/K0000800217/ It was recommended over a simple cuff style all-in-one type. I once took it and showed my doc my BP history (that unit stores past readings). He just asks me about my BP now, I guess trusting what I say.

Hmm…offering a different perspective…I had a conversation with my Japanese doctor prior to get standard metabolic and other blood tests done.

In the states they always require you to fast, but in Japan they don’t.

They would rather test your day to day levels as they really occur instead of impacting them with fasting etc.

At the end of the day things like blood pressure etc are more about comparison to baseline than anything else.

White Coat Syndrome is well-documented, and in my practice as a critical care flight medic and remote clinic clinician, as a general practice I have [non-urgent] patients seated or supine for 10 minutes before taking their BP.

This helps with both WCS and artificially heightened BP from *activity.

(Unless, I want to see how *activity or positioning or standing affects their BP.)

Japan has an interesting mix of old-timey practices and beliefs, and yet it also has far faster and better quality healthcare than I see generally practiced in Canada.

I guess I'm saying I'm not surprised that you've found WCS relatively unknown amongst healthcare workers who also still espouse other oddities, but when push comes to shove, care is very good.

I never get seen that fast, lucky you. But if a bit of stairs knock your bp and hr completely off the charts maybe the doctor was right to freak out

Op it is concerning that in your country they write a FABRICATED reading. Yes at the beginning of an appointment readings might be hight so we retake but we never change a reading. Yours a nurse who runs around a lot and is a regualar patient herself

Doctors here can comprehend that activity raises blood pressure but they must write the reading they see. Those nurses and docs that wrote different numbers in your country are wrong, it’s unacceptable.

They measure it when you’re in the room, squeezing you in as soon as they can so that you don’t wait. If you want to calm down before talking with them, arrive early and go to the bathroom to take a breather.

They do not “mess up other readings”, if you are basing it off one reading, don’t.

I don’t know that doctors in other countries write lower values.

But in Japan as far as I know, if the BP is unusually high, they will definitely test it multiple times to see if it is actually high. This is what clinics did for me.

Same here. And maybe the same for many Japanese people as well.

In my clinic in Japan you take your own bp at your discretion specifically for this reason.

There have been a few times where my blood pressure was unusually high due to nerves and they rechecked it. My blood pressure tends to be pretty low though, and there have been times when they didn't believe it was right, so they double checked then as well.

A lot of Japanese people mistakenly think that Japanese people run cold, and that 37 counts as a slight fever. I would hope that medical professionals would know better.

Tell me the numbers the doctor freaked out at, and I'll tell you if they had reason to or not...

I was ignoring the science around BP for years, coming from a familly of high BP, and it turns out, I was killing myself slowly, and the Japanese doctors way of "ahhh, okay they said it's normal, then whatever" damn near did me in. You haven't seen scared from a Japanese doctor until you've spiked over 200 on a BP reading and seen the doctor come to you whiter than your A4 paper.....

Somehow I think this is unique to your experiences with docs in Japan, and might be coming from how you are approaching them. I have far... far... (far far sob) experience with the Japanese Medical system than I would like, and it can be great if you learn how to sort of flow with it and push back only when necessary.

OP, you’ve misunderstood what white coat syndrome is. The syndrome is when your blood pressure is always high at a clinic and always normal at home, leading to potential misdiagnosis or an unneeded increase in medication. It is not someone with a high value because they just got to the doctor’s office.

I suspect high values in the office are not considered an issue most of the time because they are such a vague sign. Maybe they are more concerned about finding low values?

In Canada when I’ve had blood pressure done they always take it 2-3 times. Recently they did it 4 times, back to back (which felt like overkill to me but they did tell me about white coat syndrome as well). The numbers are always different every time but they get lower with each take, and they just make note of the lowest numbers (or whatever the average was if it was roughly the same more than once).

So yeah, it’s definitely a thing and I’ve never had my blood pressure done right away or only once, it’s always multiple times and once I’ve been there for a bit. They’ll talk to me about whatever I’m there for and kinda get me settled and comfortable before taking it if I haven’t already been in the waiting room for 10-15 minutes.

This isn’t the only time I’ve heard someone say Japanese doctors seem less knowledgeable or do things in a very different (often meant negatively) way than other countries. I haven’t had enough experience personally to say so, but if my classmates and friend’s experiences, as well as all the Reddit posts about doctors here are anything to go by, it’s a common impression.

One thing I noticed is that if you have high blood pressure and continue to deny you do, your readings get higher due to the stress of having to explain to every doctor that you don’t have high blood pressure, you are just “nervous” if the BP reading is high enough. Nervousness doesn’t justify it. If after resting your BP is like 130/85 you are still elevated. Take care of yourself, you might actually have high BP and there are symptoms you are dealing with that you didn’t even realize is due to high BP. Like a loud heartbeat or other things. (True experience…)

Ours uses a stupid machine that is oddly hard to get the arm position right. It's also right in front of everyone else. I also get generally nervous in medical spaces since a very bad anesthesia incident years ago. Result: a lot of times I have really high BP as well. I can measure it fine at home (old doc had me buy a machine to test) and it is always lower and within healthy range.

Looking forward to my yearly healthcheck in a couple of weeks, heh (though that place has a person do it which is at least more comfortable for me).

I think it depends on the clinic/facility. Clinics/hospitals outside of major cities likes to give you procedure over considerations. When I was in Japan, I got lucky that those that did tend to me just absolute love data logging me using a BP monitor I already have at home.

I think it is best to tell them a case to case example rather than asking directly for 15 minutes to wait. Tell them that your heart rate is usually lower at home, but you just ran or went up the stairs or something (Make something up!) which led to your heart beat skyrocketing. That should make them more considerate.

Also the term you'd want to tell them on your next visit is "白衣高血圧" (Hakui Taketsuatsu).

I’ve been to the same doctor three times since I arrived and no one has checked my vitals. Seems bizarre to me.

Yes, I've noticed that several times too. Why put the blood pressure test right at the start? If there is a reason for doing so, I cannot think of it. I also find that the chairs are the wrong height. The seats are too low relative to the table which means your heart is too low relative to the cuff on your arm. And the seat height often isn't adjustable. It must be worse for Japanese patients, which are smaller than Westerners on average.

They also take your temperature right after you come in and fill out your カルテ. In summer, I've been told my temperature was "suspiciously high" a few times after I had just walked in the August sun for 10 minutes....

I feel like it's one experience at a routine annual health check versus visiting your actual doctor (for follow-up etc) (tbh I did have to switch doctors a few times to find one that felt like they understood my needs/wants)

At the health check I'm usually ushered thru like a package at Amazon warehouse... they often don't have any extra time to discuss details, and they flag anything and everything (I also get high BP due to anxiety so I also give my at-home readings to the doctor at follow up for reference, and they indeed did explain the White Coat Syndrome)

unfortunately doctors here are transactional...:(

Yes, several times.

I had a doctor give me someone else’s blood pressure results. I have 2 existing medical conditions.

At hospital number 1 I say, I have x condition. They test me and tell me it’s NOT this condition. They ask a few more questions and the existing condition comes up in my history…. Then there was literally a ‘well why didn’t you say you had x as a child. It’s definitely x then.

I went to an optician, a simple thing happened.

If your reading are so high they want to send you to the hospital after a flight of stairs, i think they might be justified in their response. I am overweight (like 110kg), could walk 15 minutes, up a flight or two, and get a reading that wouldn't have them in a panic.

Easy, a Japanese person is 1 hour early for their appointment therefore never suffers from the white coat curse.

Real talk there is a lot of blind spots in medical care especially with foreigners. Weight being my #1

Here in Japan ,my regular doctor I go to understands white coat syndrome, as do the nurses at yearly physicals I've been to because I explain that I suffer from that syndrome. At my regular doctor who I visit to get BP meds every 2 months, I don't get it anymore. Anywhere else I do, so I tell them that...in Japanese...then they understand.

Mine gets taken in consultation after I've been sitting around in the waiting room for like 45 minutes, and they take it twice. Never experienced this at any doctor here

Yeah, I’ve noticed this too. If they measure right after you arrive or climb stairs, the numbers are obviously going to be high

At a rheumatology clinic I regularly visit I started refusing to use their machine. I picked up a portable omron unit for a few thousand yen and take a photo of the result taken from when calm at home.

I am sure Japanese physicians are aware of the concept of nocebo effect.

That’s what happens when university is designed not to be a learning or research environment, but a place where people go to play at clubs and nomikais. People get in and out completely uneducated.

Doctors here are complete garbage. If you have anything slightly out of the ordinary, they will just slap you with some antibiotics and send you on your way.