Introduction into the healthcare system and hospitalization can be a stressful experience on its own. Among the aspects of hospitalization considered to be most stressful Koenig et al. (1995) identified the following in a sample of elderly medical inpatients: communication problems with healthcare professionals; diagnostic and therapeutic procedures; the hospital environment (noise, rigid routines etc.); worries about the home situation and the separation from home; insufficient information about diagnosis and prognosis; and fear of dependency, loss of autonomy and control. In addition to uncertainties about their illnesses (because of unclear communication) and the unfamiliar surroundings of a hospital ward, therefore, patients encounter additional stress because they must undergo medical procedures and examinations (see ‘Hospitalization in adults’). Even some outpatient procedures such as dental treatments or blood donation can be stressful. Normally patients would report increases in anxiety in anticipation of procedures such as surgery, endoscopy, cardiac catheterization, cancer screening or chemotherapy. In addition to the anticipatory anxiety associated with the procedure itself, diagnostic procedures such as cancer screening are characterized by a prolonged period of anxiety between screening and receiving the result (Marteau et al., 1993). The same is true for procedures such as HIV testing although the development of rapid testing procedures with the provision of same-day results and counselling has reduced the negative psychological consequences associated with a long wait (Kassler et al., 1997) (see ‘Coping with stressful medical procedures’).