Whitecoat syndrome in Commercial Drivers

Last updated Apr 10, 2021 at 5:19PM | Published on Apr 30, 2016 | DOT Exams

Here’s a recent question on “whitecoat syndrome” and hypertension management in commercial drivers

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4 Comments

  1. Amelia Calderon
    Amelia Calderon on May 2, 2016 at 6:22 pm

    I know in your new form seminar you mentioned that it is examiner discretion to give consecutive 3 month cards. Unless I misunderstood that part. The facility I work in has the newest edition of the fmcsa DOT exam book and in that book it continues to say the driver can only get a 1 time 3 month card. I find this confusing. Can we or can’t we give consecutive 3 month cards?

    • Lawrence Earl, MD
      Lawrence Earl, MD on May 2, 2016 at 8:47 pm

      MEs have the discretion to certify the driver for whatever period of time is reasonable to follow up on the condition of concern. That would include consecutive 3 mo periods for any condition so warranted.
      The ME handbook is being revised. What date is the one you refer to?

      • Amelia Calderon
        Amelia Calderon on May 3, 2016 at 9:42 am

        It’s the February 2016 edition. When I mentioned that we can give consecutive 3 months the book (which we refer to often) on page 469 under hypertension section stated otherwise. So I just wanted to be sure. Thanks for the repy.

        • Lawrence Earl, MD
          Lawrence Earl, MD on May 3, 2016 at 10:20 am

          ​As far as I know, there isn’t a Feb 2016 updated ME Handbook, I still get the “being revised” page.

          Are you talking about a training book or Dr. Hartenbaums book or ?

          FMCSA has made a point to indicate that the hypertension guidelines are just that, guidelines, not rules or regulations, and that there are no “temporary certifications” just certifications of different durations, up to the discretion of the medical examiner.

          This is also in part related to updated JNC-8 HTN guidelines for those over 60 to reduce BP to <150/90.

          When there is confusion or contradiction, there is room for examiner discretion and judgement. If the driver is non-compliant and BP always remains high, don't issue another 3 mo card. If s/he is diligent about follow up and coming under control but needs further monitoring, go ahead and give another 3 mos.​