Male white coat syndrome, one very good doctor in an Emergency Department, and what eighteen months of being talked over does to a 67-year-old.
Everyone will tell you Vietnamese hospitals are short of time. They are, and it explains very little. Time explains a doctor walking away from you. It cannot explain the eye-roll, which is free. This piece is about the condition I think is actually running the ward, and about the one doctor in the country who did not have it.
Doctors have a name for the patient whose blood pressure rises the moment the white coat walks in. ‘White coat hypertension’ has a literature, a measurement protocol and a home cuff. Nobody has named the mirror image, in which the doctor’s certainty rises the moment he puts the coat on, and nobody measures that pressure at all. The coat goes on, the listening goes off, and the hospital records the visit as a success because the patient eventually left.
I propose ‘male white coat syndrome’. I have been gathering data for well over a year, mostly by being a patient.
A condition without a name
This is my term, not a diagnosis. It describes what I have watched in hospitals in Đà Lạt and Ho Chi Minh City: a doctor whose conclusion has been reached before the patient has finished describing the problem, and who treats the rest of the consultation as a formality, like the safety demonstration on a flight.
My wife has watched it from the other side of the desk. So have her female friends. Here’s just one example of what they have to go through…
One day, a woman friend rang me from her home, in tears. She had left work at lunchtime because she was in so much pain. Those who know the work culture of Vietnam know how rare such an event is—she would lose pay for the time she was away, and money in this country for workers is not generous. I rode to her house, held her hand while she sobbed, and insisted we visit a specialist clinic for her pain (it was uterine). Against her express wishes, vocalised through tears, I booked a Grab car and bundled her into it, and we went to a specialist women’s clinic. She was silent throughout the trip. At the clinic she shuffled through the doors, bent over in pain. After a short wait for the first available appointment, she was escorted into an examination room and I was left in the waiting room. Ten minutes later she emerged, still obviously in pain but trying not to show it. The young male doctor had given her what looked suspiciously like two paracetamol and told her to come back in three days if the pain had not subsided. Unhappy with her condition and his dismissal, I asked him to come back out to the waiting room and explain himself. He refused to look at me and directed his gaze at my friend, who was sitting down in obvious pain. He told her that if she wanted more care she would have to go to a hospital. Angry, I assured him we would. My friend was by now very obviously fearful of going to hospital, and I soon found out why.
By the time we got to Hoàn Mỹ Hospital, the consulting day was over. The female nurse on duty would offer no help other than for my friend to return the next day. My friend was crying in pain and obviously distressed. But she was also adamant, as much as she could be with a loud and angry Western friend, that she wanted to go home and that all would be well in a day or two.
Eventually, I created enough of a scene with the nurse that we were shuffled off to a side corridor, away from the throng and outside an office where a young male doctor sat. My friend was by now in great fear and had, to all intents and purposes, checked out; she was dissociated. The doctor asked her what her symptoms were (from behind his desk; he never once thought to step around it and deal with the woman on the other side of it) and, as she explained to me later, she said nothing was wrong because she just wanted to get out of the hospital and away from the male white coats. I insisted to the doctor that she was in obvious pain and needed help, but he steadfastly refused. I asked for a senior doctor to be called in, which he refused. Repeatedly. I repeatedly asked, and eventually one did arrive—it could just as easily have been a security guard. He gave my friend one look and one question, and told me he would not treat her because she said she was ‘fine’.
She was dissociated, in tears of pain and fearful of her environment, but because she had said she was ‘fine’ he refused to treat her. I know a doctor is entitled to take a patient’s word. ‘Fine’, said through tears by a woman bent double, is not a word a doctor is entitled to take at face value.
I mentioned this to other women I am fortunate to know in Đà Lạt. To a woman, they told me it matched their own experience, and it is why they strongly resist going to hospitals or male doctors: the shame, the humiliation and the denial of symptoms.
Other women have told me that the male doctors present at their childbirths were similarly dismissive of the women’s pain. Some used a word that Google translated to ‘butchered’ to describe what their male specialists had done to their insides during the birth and shortly after.
Our shared conclusion, reached without a spreadsheet, is that the women doctors we have met here arrive with more humility and a longer list of questions. I cannot emphasise enough how wonderful the female doctors in Vietnam are. They care, they work with the patient, and they do not exist to ‘dish out a tablet and think their job is done’. Most importantly, they listen. These are two women doctors I hold in such high regard:
• Dr Hồ Viết Lệ Diễm, DH-Med Clinic, Đà Lạt (Zalo: 0914 584 990; dhmed.vn)
• Dr Lưu Hồng Diễm, SIHG, 16 Tôn Dật Tiên, Phú Mỹ Hưng, Ho Chi Minh City (sihg.vn/)
Women throughout history
I am fortunate to be co-writing a book about menopause and perimenopause with long-time colleague and friend, Gaye Idec. Gaye has lived through the whole perimenopause shit-fight with her body and has a book full of experience in dealing with white coat dismissal.
What shocked me, as a man, was the extent, and the centuries, even millennia, of women’s pain and experience being dismissed or flattened by male white coats.
Start with the womb. Hysteria is one of the oldest diagnoses in medicine, described as far back as the second millennium BC, and Tasca et al. (2012) trace more than 4,000 years of it, with cures that ran from herbs and sex to abstinence and, for women suspected of sorcery, fire. The word comes from the Greek for womb, which tells you where the profession thought the problem lived. A wandering womb is a wonderfully efficient diagnosis. It explains every symptom, requires no examination, and cannot be contradicted by the patient, whose opinion of her own womb is, by definition, hysterical.
Until Freud it was considered an exclusively female disease, and the official psychiatric diagnosis was not deleted until the DSM-III in 1980 (Tasca et al., 2012), the year I turned twenty-two. Nor is this ancient history. Hoffmann and Tarzian (2001) reviewed the research on gender and pain and found women’s pain underappreciated and undertreated, with a habit of attributing it to emotional or psychological causes. The womb has stopped wandering. The explanation has simply moved house, from her uterus to her nerves.
And it is not only Vietnam
On 3 October 2026, The Age reported on a leaked analysis of the on-call obstetric anaesthetist roster shared by two private hospitals in Melbourne. Women anaesthetists held 315 of the 1,753 shifts, about 18%, although they make up 36% of the specialty’s fellows and 43% of its trainees. These are the doctors who give women epidurals and spinal blocks in labour, and the shifts can pay up to $10,000 a day. A female anaesthetist who feared retribution if named said the roster was tightly held by a small group of men, and one hospital has called in an independent audit (The Age, 2026).
The roster’s defenders say shifts follow a rolling system weighted by past contributions, and one of them concedes that the roster was previously heavily male-dominated. A system that allocates the future by the past will reproduce the past, which is what pasts are for.
Three implications follow. First, this is not a Vietnamese peculiarity or a Hoàn Mỹ peculiarity. It is Melbourne, with some of the best-resourced hospitals on earth, and the pattern needs no Vietnamese hierarchy to explain it. Second, I am not claiming that male anaesthetists treat labouring women worse. The story is about pay and access, not outcomes, and the allegations are unproven and under review. Third, it matters to the argument here. A profession that cannot see who is missing from its own roster is poorly placed to notice who is missing from the consulting room. The male white coat is not only an attitude. In places it has a roster.
What the research can and cannot see
The research is more careful about leaping to a judgement than I am. A meta-analysis of 26 studies found that visits with female primary care physicians ran about two minutes (10%) longer and held more patient-centred talk, with no difference in the biomedical information given; obstetrics and gynaecology may show a different pattern (Roter et al., 2002). A US study of nearly three million Medicare patients aged 65 to 99 having surgery found the gap in 30-day deaths between the four doctor-and-patient gender pairings small enough that the authors judged it not clinically meaningful (Wallis et al., 2023). The research on how women’s pain is treated is, however, far blunter. In one American emergency department, men and women with acute abdominal pain reported similar pain scores, yet women were less likely to receive opioids (45% against 56%) and waited a median of 65 minutes for analgesia against 49 for men (Chen et al., 2008).
So, I will not claim that women doctors keep patients alive better. I will claim something nobody measures. Humility is not a variable in anyone’s meta-analysis, and it is the one I can detect through a closed door.
What I met at Hoàn Mỹ
I have met the male white coat at Hoàn Mỹ myself, in its natural habitat. Twice. On both occasions, eyes were rolled. Doctors turned and walked away to attend to other patients. Walking away from a patient is a precise piece of communication. It says that the sentence you are in the middle of was optional, and that somewhere in the building there is a better use of the doctor’s time. It leaves you talking to the furniture, which at least did not roll its eyes.
In the solar system of an outpatient and especially an Emergency ward, the doctor is the sun, the paperwork is the weather, and the patient is a minor moon whose orbit has been calculated in advance. A moon that arrives with a translated dossier is an unscheduled comet. Sensible suns ignore comets for the same reason I ignore software updates: they are probably trying to change something.
I had my symptoms and background translated into Vietnamese, carefully, so nobody had to rely on my English. The translated pages went unread. A document built to remove the language barrier was treated as the barrier.
The same off-the-wall arrogance turned up in the psychiatrist I saw at FV on my last visit. An eye-roll costs a doctor no time at all. It is the only free item in the hospital.
The one who listened
Dr Trịnh Văn Hải in the FV Emergency Department is the one male doctor in this country who has actually listened to me. I want his name in print. He treated my account of my own body as data rather than rumour, and I would like every male white coat in Vietnam sent on a short placement in his department.
Why nobody complains
The usual excuse is time, and it is very real. In a national survey across six Vietnamese provinces, doctors said they had about 10.8 minutes per consultation and needed about 17.6 (Tran et al., 2020). Time explains the walking away. It does not explain the eye-roll, which takes no minutes.
The same survey is more interesting for what it fails to hear. Of 480 patients, 93.3% said their doctor listened attentively, and 52.9% said the doctor checked he had understood exactly what they said. Somewhere between those two numbers is a doctor who listened and understood nothing, which describes my year and a half here. The authors suspected that patients were easily satisfied or held low expectations, in a society where doctors sit above patients and patients accept their lower place (Tran et al., 2020). A survey run inside a culture of politeness returns the results of politeness.
A foreigner with typed symptoms and the old-fashioned belief that a doctor’s job includes reading them is, statistically, the survey’s silent remainder. My reading, as one patient with an Honours degree in applied Psychology and Sociology and a Master of Counselling Practice, is that a system where patients rarely object teaches doctors not to expect objection. The male white coat is what that looks like once it has set.
What it costs a body of my age
The feeling underneath all of this is ‘dismissal’. I am 67, in a country where I do not speak the language of the consulting room, carrying a body that has hurt almost every morning for over a year. Being dismissed from that position does not feel like an insult. It feels like being quietly removed from the record of my own life. I trained to sit with people and listen for a living, so I know what it looks like when it is done properly, which makes the other thing harder to take.
The bill is measurable. Every consultation that ends unheard is a withdrawal from an account an older body has less of. McEwen (1998) named the wear that builds when the stress response never stands down as ‘allostatic load’, and Seeman et al. (2001) followed 1,189 people aged 70 to 79 and found that higher scores predicted death within seven years and declines in cognitive and physical function. Persistent pain sends its own invoice: in a US cohort of 10,065 older adults, those who reported ongoing moderate or severe pain showed memory decline 9.2% faster than those who did not (Whitlock et al., 2017). That is a modest association, not a verdict, and my headache is not a dementia forecast. It is a bill that arrives daily and is paid from the same account as everything else.
Noise sends a third invoice. A Lancet review (Basner et al., 2014) gathered the evidence on noise, sleep, the heart, cognition and mental health, and concluded that the public health effect is easily underestimated. I lived for a year with noise I could not switch off: an open-air live-music venue and three nearby karaoke restaurants, all trying to out-volume each other—each venue’s amplifiers went to 11. The venue is about 400 m from my balcony with no buildings or trees between us, and my phone app logged peaks of 100.2 dBA against a government-set evening limit of 50. I hardly slept. Then, to add insult to injury, the unfinished buildings on the other side of my balcony suddenly became sites of intense construction, starting before 6 am every day, Sunday included. When I moved into a quiet house, I slept. One patient, no control group, a sample size I would refuse to cite in anyone else’s work.
None of this appears on the discharge summary.
What I would do differently
Four things, in the order I wish I had learned them.
1. Carry one page of history in Vietnamese and expect it to go unread; carry it anyway, because the next doctor might be a Hải.
2. Ask the doctor to say back what they have understood before they tell you what they think.
3. Bring a family member who is allowed to be annoyed on your behalf, even though it did no good at Hoàn Mỹ Hospital on two separate occasions. My Vietnamese wife, my advocate, was ignored anyway, twice.
4. And when you find a doctor who listens, keep the name, and tell other people.
My translated pages are still in their folder, in two languages, in the correct order. I have them on my phone, ready to Zalo (think Vietnam’s ‘Messenger’) to the medical team the moment they are ready to receive them. They would take less than two minutes to read. You can download mine and make your own handout for medical teams when you enter their environment [h/t Jon Mick for the idea]. Ask your practitioners to enter the form into your medical records and flag it as important, so that you do not have to repeat yourself at the next visit.
Well, hopefully, anyway…
References
‘A bit of a boys’ club’: Female doctors locked out of lucrative work at top hospitals. (2026, October 3). The Age.https://www.theage.com.au/national/victoria/a-bit-of-a-boys-club-female-doctors-locked-out-of-lucrative-work-at-top-hospitals-20261003-p611z5.html
Basner, M., Babisch, W., Davis, A., Brink, M., Clark, C., Janssen, S., & Stansfeld, S. (2014). Auditory and non-auditory effects of noise on health. The Lancet, 383(9925), 1325–1332. https://doi.org/10.1016/S0140-6736(13)61613-X
Chen, E. H., Shofer, F. S., Dean, A. J., Hollander, J. E., Baxt, W. G., Robey, J. L., Sease, K. L., & Mills, A. M. (2008). Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Academic Emergency Medicine, 15(5), 414–418. https://doi.org/10.1111/j.1553-2712.2008.00100.x
Hoffmann, D. E., & Tarzian, A. J. (2001). The girl who cried pain: A bias against women in the treatment of pain. Journal of Law, Medicine & Ethics, 29(1), 13–27. https://doi.org/10.1111/j.1748-720X.2001.tb00037.x
McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179. https://doi.org/10.1056/NEJM199801153380307
Roter, D. L., Hall, J. A., & Aoki, Y. (2002). Physician gender effects in medical communication: A meta-analytic review. JAMA, 288(6), 756–764. https://doi.org/10.1001/jama.288.6.756
Seeman, T. E., McEwen, B. S., Rowe, J. W., & Singer, B. H. (2001). Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proceedings of the National Academy of Sciences, 98(8), 4770–4775. https://doi.org/10.1073/pnas.081072698
Tasca, C., Rapetti, M., Carta, M. G., & Fadda, B. (2012). Women and hysteria in the history of mental health. Clinical Practice & Epidemiology in Mental Health, 8, 110–119. https://doi.org/10.2174/1745017901208010110
Tran, T. Q., Scherpbier, A. J. J. A., van Dalen, J., Do Van, D., & Wright, E. P. (2020). Nationwide survey of patients’ and doctors’ perceptions of what is needed in doctor-patient communication in a Southeast Asian context. BMC Health Services Research, 20, Article 946. https://doi.org/10.1186/s12913-020-05803-4
Wallis, C. J. D., Jerath, A., Ikesu, R., Satkunasivam, R., Dimick, J. B., Orav, E. J., Maggard-Gibbons, M., Li, R., Salles, A., Klaassen, Z., Coburn, N., Bass, B. L., Detsky, A. S., & Tsugawa, Y. (2023). Association between patient-surgeon gender concordance and mortality after surgery in the United States: Retrospective observational study. BMJ, 383, Article e075484. https://doi.org/10.1136/bmj-2023-075484
Whitlock, E. L., Diaz-Ramirez, L. G., Glymour, M. M., Boscardin, W. J., Covinsky, K. E., & Smith, A. K. (2017). Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders. JAMA Internal Medicine, 177(8), 1146–1153. https://doi.org/10.1001/jamainternmed.2017.1622
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