Sunday, April 24, 2011

Why Don't Men Visit Doctors,
Is Embarrassment a Factor?

     by Joel Sherman MD

This article has been chosen for re-publication on Kevin MD blog.

It is well known that men see doctors much less frequently than women.  The reasons are multifactorial and not all that well studied.  It’s certainly not because men are healthier than women as they die on the average seven years before women.  Clearly women are accustomed to seeing doctors at an earlier age than men for reasons relating to childbirth and birth control.  Most accept the recommendations to get an annual physical with Pap smear.  Men on the other hand typically don’t even think about seeing a doctor before the age of 40 unless they have a specific injury or acute illness.  Routine annual physicals for men under 40 are a hard sell.  A large percentage of men actively avoid seeing doctors even when they’re older.

According to a recent survey published in Esquire (April 2011) only 37% of men have seen a doctor in the last year.  Another third have not seen one in over a year.  Ten percent can’t even remember when they last saw a doctor.  Forty five per cent don’t have a primary physician.  The comparable number for women is 20%.  Of men in their 40’s, 20% have never had any preventative tests including prostate exams or blood tests, colonoscopy, diabetes screening and cholesterol measurements.  The questionnaire didn’t ask about blood pressure which along with blood tests are perhaps the most important screening tests.

Why are men so lax about their health?  Good studies on this issue are scarce.  The best I have seen is a Canadian study:  Fred Tudiver, Yves Talbot. Why Don’t Men Seek Help? Family Physicians Perspective on Help-Seeking Behavior in Men.  Journal of Family Practice, Jan. 1999.  The study consisted of gathering focus groups of primary physicians in Toronto, randomly chosen, and submitting to them a standardized series of questions in interviews.  Two thirds of the physicians were men, one third women.  

Their conclusions are divided into three areas.  Faulty support systems are a significant factor for men.   Men do not talk to their peers about health problems to anywhere near the extent that women do.  Women routinely compare notes with their friends about health problems, child bearing and rearing.  The only time men discuss health issues with their friends is when it is a ‘safe’ topic such as sports related injuries.  For other issues, men will be far more likely to discuss the matter with their wives or partners than anyone else.  But men are reluctant to discuss personal issues at all.  Some physicians noted that when men come, they are loathe to bring up personal problems but instead hope that the physician will ask directly.  The comments of some contributors to this blog are correct; women do indeed have to encourage their men to get medical attention.

When do men seek help?   They generally wait till they’re older with major health problems before coming on their own to see physicians.    In other words, men needed to feel very vulnerable before they seek medical attention even with the encouragement of their partners.  One positive trend is that younger men do seem to be more receptive to the encouragement of their partners to get medical advice earlier.  A common scenario is that women will berate their partners for not getting enough exercise, smoking or drinking too much and will push their guys to get medical assistance.  Some will follow through.  Probably similar to women, men are more likely to come if some of their friends have had recent illnesses, especially prostate cancer.  The physicians felt that women were far more likely to present with general complaints such as malaise whereas men waited till they had a specific complaint such as a new musculoskeletal problem or a required physical exam for employment purposes.

Barriers to seeking help can be divided into personal and systemic.  The systemic factors affect both men and women equally, especially nowadays when most women work similar hours to men.  Specific issues included long waits for appointments and long waits in the waiting room.  A common issue more embarrassing to men is being asked the reason for the appointment at the front desk.  This occurs because nearly all receptionists are women.

Concerning personal issues, the study also noted this:  Several participants stated that they thought the lack of a male physician was a barrier for some of their male patients, especially those in the younger age bracket.
"My assistant is a woman, and I think that is sometimes a bit of a hindrance, especially talking about personal issues with trying to get an appointment for such and such a thing.... I think men feel much more sensitive, especially male teenagers ... very secretive about anything having to do with their genital organs."

Thus multiple issues keep men away from doctors.  Different factors influence individual men to varying degrees but there is little doubt that privacy and embarrassment factors play a role in many, especially younger men.  Men, more so than women, feel they need to be in control and are loathe to surrender their autonomy.  For most men it is more embarrassing to lose control to women and many men will not talk about sexual issues with women.  Women have much less difficulty with these issues.  This study does not quantitate what percentage of men is affected by these issues but it is clearly substantial.   Important information is still missing.   A large patient survey asking these questions directly to patients would help clarify the issue though it would still be hard to get an accurate picture.  Men are not only loathe to discuss their discomfort with women, they are also loathe to admit that the presence of women would embarrass them.  It is striking to me that men, when they do seek medical help, frequently do so for intensely personal issues such as sexual dysfunction whereas they are far less likely to present because they are concerned about more important risk factors such as hypertension or high cholesterol.  This study is rare in that it actually considers issues such as gender preferences, modesty and embarrassment.   The vast majority of medical studies prefer to view all patient physician encounters as gender neutral and to ignore a factor that nearly all patients are aware of and probably most are concerned with.

Saturday, April 16, 2011

Patient Rights with Regards to Electronic Records
Guest article by Alexis Bonari

Understanding Your Patient Rights with Regards to Electronic Medical Records
 Certainly moving patient records from a paper to digital format is a big help to the medical industry. In the past, diagnoses were often made without taking into account the patient’s medical history. You add on top of this the number of specialist physicians and patient relocations and it’s no wonder that the paper trail was so easily lost.
Alexis Bonari
Electronic records don’t come without some amount of controversy though. Given the difficulty of maintaining private electronic records of any kind it’s understandable that people should hold concerns and reservations over this technology. While the federal government has tried to assuage concerns over this new use of technology there have been a growing number of reports on the abuses of this system.
In this article we go over what your rights are with regards to electronic medical records and to medical records in general. We lay out what the dangers are in storing medical records electronically, including cases of medical identity theft. We also discuss some of these recent stories and what resources you have available to try and make sure these things don’t happen to you.

HIPAA Regulations
The Health Insurance Portability and Accountability Act (HIPAA) is the primary piece of legislature regarding patient privacy rights. Enacted by Congress in 1996, this law has far reaching consequences and HIPAA training is mandated by law for all health professionals. Although it covers a very large range of health care issues, we will be discussing those that are relevant to electronic medical records.
The specific section of this law that concerns us is the HIPAA privacy rule. It defines your medical records as individually identifying health data and refers to it as Protected Health Information (PHI). The law explicitly tries to balance the need between protecting patients’ privacy with the need to protect the public’s health. In doing so it specifically outlines that your personal health records are legally able to be supplied to public health professionals without your consent.
For health care professionals, the Privacy Rule contains these rules:
·         To notify patients of their rights and how their PHI is disclosed.
·         That health professionals need to be trained in how to keep PHI private.
·         Designate positions for handling PHI related matters.
·         Establish privacy requirements in contracts with business associates.
·         That health professionals need to implement internal procedures in order to keep your records safe.
·         Civil and criminal penalties to health care professionals that ignore these safeguards.
·         Limits the amount of information released to only what is needed for the study.
With regards to individual patient rights, the HIPAA Privacy Rule contains these provisions:
·         Allows patients to find out what disclosures of their medical records have been made. Some exceptions include disclosures with individual authorization, ones related to treatment, and payment and health care operations.
·         Gives patients the right to obtain their medical records and request corrections. Exceptions include psychotherapy notes, information for use in civil, criminal, and administrative actions, and PHI that is subject to the Clinical Laboratory Improvement Amendments of 1988. If corrections are requested the requirements are that the records must be identified, a link must be provided to the amendment, the patient must be notified when the amendment is made, and other covered businesses must be informed of the amendment.
·         Gives patients the right to control certain disclosures of their medical records.
·         Allows patients to receive a notice of when their medical information is shared and with whom.
Despite all of these rules there continue to be instances where health providers are either hesitant to provide patients with records, or records have been maliciously altered. Certainly, with the number of malpractice suits at an all time high, there is a conflict of interest at play here.

Instances Where Health Providers Either Deny or Hesitate to Disclose Information
These complaints haven’t really surfaced in connection with healthy patients, but at times when something has gone wrong. There have been instances of parents being denied the medical records of their children after they have passed away under mysterious circumstances. While HIPAA has allowed health practitioners greater access to your records, there is growing concern that they aren’t providing full disclosure to patients when they are at risk of facing a malpractice suit. Under certain circumstances they are allowed to withhold information, but they must submit in writing why they are doing so.
If you find that you are in this situation there are certain routes you can take. The following lists these various outlets:
·         State Medical Boards run by the American Medical Association are known to investigate these issues.
·         The Joint Commission on the Accreditation of Health Care Organizations is the body responsible for certifying health care providers and will also investigate these claims.
·         The Agency for Health Care Research and Quality investigates certain claims for people who register with them.
·         The American Civil Liberties Union has a number of ongoing cases related to patient’s rights.
As of this writing there are no special laws concerning electronic medical records. They are covered the same as paper records, and the primary underlying law is HIPAA. If you have concerns that you are being treated unfairly or in a criminal manner by your health care professionals there are resources available to you. Like many things in life, the more proactive you are in safeguarding your PHI, the less likely you will be to fall victim to abuse.


 HIPAA Priavcy Rule & Public Health

Bio: Alexis Bonari is currently a resident blogger at College Scholarships, where recently she’s been researching health administration scholarships as well as health informatics scholarships.