Sunday, April 24, 2011

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

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.

86 comments:

Maurice Bernstein, M.D. said...

To understand how physicians evaluate their patient's modesty embarrassment would be to find whether there are surveys which document to what extent physicians themselves seek routine medical care or disclose modesty issues which lead to gender selection for their own healthcare providers. If physicians of both genders have such gender selection tendencies for themselves, wouldn't and shouldn't the doctor be less ignorant and more "in tune" with their patients who make similar requests?

I know there are surveys which show that physicians themselves may be living "unhealthy" lives despite what they tell their patients about health issues. What I am still trying to find is how modesty, either intellectual shyness to admit life-style or actual physical modesty fears play a role in the behavior of those physicians with regard to their own health. Anyone have any data regarding this aspect of the patient modesty issue? ..Maurice.

Anonymous said...

This is right on the money for me and I would suspect numerous men. I can not tell you how many times I have gone into the doctors offcie with a specific ailment in mind and never brought it up. I walked out frustrated, angry with being asked to tell a womam I know I had a lump on my testicle, or I wanted a vasectomy, or I thought ai had hemroids. Angry at myself for not having the guts to say something. I have started printing and copying Dr Shermans articles and sending them to multiple Dr's and hospitials in the area. Some I sign some I don;t, While I know it would be best if I signed them all...its steps fold, steps vs some grandious plan,,,and this is one thing I can do, it may not the the best, it may not be the most, but it is what I feel comfortable with and it is something I can do, if we all do something it adds up and we find comfort in this, then that, and we keep moving up.....thanks Dr. Sherman, Doug, & Suzy I use your articles to send to numerous people.....alan

Doug Capra said...

Excellent article, Joel. As you say, the study you quote at least discusses important gender issues. Most studies don't. I notice lately on Dr. Bernstein's blog there's been a lot of banter between males and females about who has it worse as far as modesty treatment goes. This has to stop. One thing the study you quote points out is that many men do depend upon their significant others for support, since men don't have the group support that women often do. So...men and women need to work together to educate the medical community to improve this situation. We need to provide caregivers with specific, concrete suggestions as to what they can do to make things better.

Anonymous said...

That Dr Bernstein is a very interesting question. I think it is what I would call the big denial. I recall very clearly a flight many years ago sitting next to two Dr.s and one telling the other how embaressed he was having an emergency appendecomy in his own hospital where he knew the staff. It was interesting from the point that this man was a surgeon and no doubt on a regular basis expected his patients to shed their inhibitions when he wore the scrubs. And while providers try to explain this with we know these people, I would counter if you truely feel you and others are professionals and its no big deal and therefore that provides a reason for patients to feel free to shed their modesty, should you not be comforted by that knowledge when you are the patient with the opposite gender. And yet they expect men to be fine with female receptionist, female nurse, etc etc. I really do appreciate you looking at this. While men die 7-8 years younger than women, we are 30-40% MORE likey to develop cancer, and yet, all you see on tv is breast cancer and female nurses, etc. is it any surprise we don't feel comfortable in the medical community, I know from personal experience and from convesations, it is a factor....alan

Anonymous said...

This subject matter has already been addressed by
Dr orange. She is an expert on mens health and knows
what's best for us.


PT

Joel Sherman MD said...

Actually PT, sarcasm aside, Dr Orrange at least recognized that many men are embarrassed and made uncomfortable by genital and rectal exams. What she didn't get is that it's no reason to make fun of men or speak in a degrading way. Many doctors are so used to doing these exams and pelvic exams that they become totally oblivious to what patients are feeling.
Dr B, I'm sure that there are no studies which look at how physicians deal with their own modesty and embarrassment as patients themselves. I've wanted to write the above article for a long time, but held off because I couldn't find any very useful information. Just discovered the Canadian article recently.

Jan Henderson said...

Excellent post, Dr. Sherman. There is one type of study that may be related to this, though not explicitly. Kristen W. Springer (Rutgers, Robert Wood Johnson) studies the correlation between early male mortality and “stereotypical notions of masculinity” (belief in traditional gender roles). You may be familiar with her work. She published something in 2009 and there was just a new study this April (http://bit.ly/mIWLYy) in the Journal of Health and Social Behavior. This most recent study finds that men with strong masculinity beliefs are 46% less likely to seek preventive care.

She doesn’t consider patient modesty, so it would be pure speculation to suggest that there could be a correlation between strong masculinity beliefs and a male aversion to female health care professionals.

There’s an article in Good Men Project magazine by someone who talks about what Springer’s study means to him personally (http://bit.ly/mC00N0). He’s an older parent of a young daughter and his father and grandfathers died young.

Anonymous said...

Good to hear from you again, Jan. The study you mention is interesting...but, the fact that she doesn't even consider male modesty is telling. In fact, it's indicative of the problem. As you know, you learn as much about the world view of a researcher by the questions they don't ask as by the questions they do. Many, studies that consider questions like respect, dignity, patient satisfaction, etc. don't examine the kinds of modesty violations discussed on blogs like this. They just don't "see" them. They're invisible. Every profession is socialized to "see" certain things and "ignore" other things. Not seeing doesn't mean they don't physically see; it means what they see they don't regard as relevant to what they're studying and thus these "sights" eventually become "invisible" to an study done.
The fact that there might be a connect between views of masculinity and modesty is alien to certain world views.
Doug Capra

Joel Sherman MD said...

Thanks Jan & Doug.
I have read thru the entire paper whose abstract you linked to. It's a difficult read for a non sociologist and is centered on the theory of 'hegemonic masculinity.' Wikipedia defines it: In gender studies, the theory of hegemonic masculinity refers to the belief in the existence of a culturally normative ideal of male behavior. Hegemonic masculinity posits that society strongly encourages men to embody this kind of masculinity. Hegemonic masculinity is said to be marked by a tendency for the male to dominate other males and subordinate females. It may derive from feminist gender theory.
The paper really makes no attempt to look at all factors that influence why men avoid doctors, focusing alone on this theory and its interaction with socioeconomic status. They don't mention embarrassment or modesty, though certainly the loss of control I refer to is a major source of embarrassment. Their major finding is that increased levels of machissmo (or hegemonic masculinity) result in decreased preventative health care and higher levels of socioeconomic status do not help; may make it worse. The latter point is interesting and of concern. Of importance, the paper only looked at older men near 65. We know factors of modesty and embarrassment are more acute for younger men.

Anonymous said...

I think men go to the doctor less frequently than women because they're smarter! Consider this: Numbers show that women go to the doctor more probably because so many of them have bought into the fear/disease mongering and dutifully report each year for their "well women" exams instead of asking "is this valid for me?" based on their individual health status and lifestyle. Why does someone need a well woman exam if they're already well??? This current trend of "preventive" care is really a way of early detection and/or labelling people with pre-conditions, which is not acutally preventing anything. Prevention should focus on what people can do on their own and I don't need to pay a doctor to tell me how to live a healthy lifestyle: that information is readily available from numerous (free!) sources. No wonder our health care system is overburdened - too many "worried well" overusing the system!

The men I know, including my husband, do not hesitate to see a doctor when they don't feel well, which is how it should be in my opinion. As far as this being a reason women outlive men, I don't buy that either. My father saw a doctor considerably more often than my mother who rarely saw one at all, and he still died at a younger age than she did. I think medicine can do wonderful things when people are sick and the advancements in treatments and cures is probably what has extended our life spans and not necessarily these yearly checkups and screenings. I would highly recommend people read 2 books by Dr. gilbert Welch: "Overdiagnosis" and "Should I Be Tested for Cancer: Maybe Not and Here's Why". They are very enlightening! Jean

Joel Sherman MD said...

Jean,
I partially agree with you that routine annual well patient checkups don't accomplish a heck of a lot. They are certainly oversold in this country and likely contribute more to the physician's (financial) health than the patient's. However some routine screening is appropriate such as blood pressure checks and blood work including cholesterol and sugar. These type screenings do not need a physician, but can easily be done by lower level providers. The catch is that many patients are either not self aware enough to recognize symptoms or refuse to take them seriously until damage has been done.

Albert said...

This is my first post and before I toss my two cents into the mix I want to extend a heartfelt thanks to Dr. Sherman, Dr. Bernstein, Doug Capra, and all my fellow human beings who have taken the time to share their views and life experiences on issues that are so deeply imbedded in, and lie at the core of present day American healthcare. I found my way here while doing research on what I call the male/female Death Discrepancy Age, looking for the underlying cause or causes why (USA) females consistently outlive males. I am retired now and I have been able to devote countless hours to this most daunting challenge, so I share these thoughts with you.

I used 1920 as a base year for the male/female DDA because it cleared the war dead from WWI and allowed for an entire generation before reaching the war dead from WWII. In 1920 the DDA was just less than two years in a life expectancy just short of 60. By the mid 1980s the DDA had ballooned to 7+ years with a life expectancy of just under 80.

Surely the three wars (WWII, Korea and Vietnam) played a part but could not have entirely accounted for this catastrophic result. This was a 350% increase in DDA as against a 33% increase in life expectancy. Males, incredibly, gave back five out of the 20 years gained in expectancy from 1920 to 1985.

In actuarial terms this was mindboggling. Thankfully, the next 15 years saw the DDA recede to a 5+ level but has not been able to budge from there over the last decade. I know Alan has posted here and elsewhere that the DDA is 7/8 now but I just can't find that number anywhere. If that number is accurate I would love to incorporate it into my work.

Nevertheless, at 5+ the DDA is now up 250% from the 1920 base. I can accept that the Great Depression, World WarII, Korea, rebuilding a postwar America, and sending their sons to Vietnam took an awful toll on my father's generation and accounted for much of the 7+ ballon in the mid 80s. So now the big question is, what accounts for the 5+ disparity (and if Alan is correct it's an ungodly 7+) that exists today? I'll share my thoughts in a subsequent post.

Albert

Joel Sherman MD said...

Albert, thanks for your thoughts. I do not know what the most current age differential is right now off hand. It's usually given as 5-7 years depending on who you read. But there should be definitive federal statistics available.
I also have not looked at it chronologically over decades. Wars are clearly one factor. I'd think the decline in maternal mortality since 1920 would also be a big factor.
Do give us the rest of your thoughts.

Anonymous said...

I agree with you, Dr. Sherman, that blood pressure checks and blood lipid, sugar, etc. levels are important information to know but you can get those at community screenings and even buy a blood pressure monitor for a reasonable cost and monitor your own, which actually may give you a more accurate recording than having a once-a-year reading at the doctor. And, yes, I agree that a lot of people do not manage their own health and therein lies the biggest crises, IMO. I know quite a few people that prefer to go to the doctor and get pills to control high blood pressure, diabetes, cholesterol, and any number of lifestyle related conditions instead of changing their habits. But I still do not agree that men die at a younger age than women simply because they don't see a doctor as regularly. As I said, the men I know do see a doctor when they are symptomatic and they do not wait until those symptoms are too far along and major damage has been done. But that's just the ones I know, which is a small percentage.
I think Albert's comments are very interesting, also, as they bring up some other issues that may impact the death age ratio between men and women. But maybe it's just a biological fact that can't necessarily be explained. Who knows? Jean

Joel Sherman MD said...

Jean, I didn't mean to imply that the only reason men die younger is that they don't see doctors as frequently as women do. It's likely part of the reason, but not the only one. Indeed, it's not merely the frequency of visits that's important but the promptness of the visits when there is a perceived problem. Your men may be reliable but probably half of all men are not. Half don't even have a primary physician whom they can see easily. And more men than women put off seeing a doctor until it's too late or the problem has progressed to a more serious stage.
As I stated, I don't believe that annual checks ups in young asymptomatic people accomplish much.

Joel Sherman MD said...

Published today:

In an online survey by the American Academy of Family Physicians, 85% of men said they only sought medical treatment when they got sick and 92% said they only went to the doctor after waiting a couple of days for it to 'take care of itself'. A whopping 30% said they'd wait as long as possible to see if they'd get better before even making a doctor's appointment.

Anonymous said...

I guess I'm more like a man, then, because I don't have a primary care physician either and I'm 57 years old. I don't go in for regular checkups because I always feel great. Just don't see the point. I also will wait several days if I don't feel well to see if the problem will resolve on its own, which it usually does. I suppose I live in a bit of a bubble; just don't have a lot of friends or family that have had a lot of medical issues (but those that have have always sought care in a timely fashion). I was just brought up to believe that you only saw a doctor when you were sick so it is hard for me to understand the current trend of seeing one on a regular basis, sick or not. So, I am middle-aged and still do not see the validity of yearly exams for my age, health status and (healthy) lifestyle. I also do not know any men who forego seeing a doctor merely because of the embarrassment factor; that actually describes me more and I am a woman! It is hard to make generalizations about people but I suppose conclusions have to be drawn from how the majority of the populace acts. Nevertheless, I think the modesty issue in medicine should be addressed better for both sexes. Jean

Albert said...

Hello, again. When dealing with a male/female discrepancy of any sort, and trying to identify a cause in a cohort ranging from 100 million (1920) to 300 million (present) it becomes absolutely necessary to consider only endemic factors, and the greatest endemic factor in humans is our genetics. Accepting the premise that it takes Mother Nature many thousands of years to make significant changes, and keeping in mind that we are dealing with a window of 90 years, it becomes intellectually and logically certain that genetics has played no part in the abrupt changes in DDA over the past 90 years. Indeed, genetics has been a constant. So, then what.

If we are not varying from within, then we must look outside, and my statistical research has revealed some stunning truths. Looking towards factors such as lifestyle which uncovers an undeniably riskier experience for males as against females, all of the attributable greater number of male deaths would not move the DDA one month. This includes auto deaths, alcoholism, murder, illicit drugs, sports, (feel free to include your own favorite)sexual carelessness, tobacco, etc. The 100 to 300 million cohort swallows this up like an eyedropper of water into your favorite lake.

To drive this point home, Dr Sherman came up with a factor that is near and dear to me, as I spent many years in the OBGYN medical malpractice arena as a court reporter and was very much aware of the spectacular achievements of this group of doctors in reducing the maternal death rate from 600 per 100k births (1915) to less than seven per 100k births in the recent past. Simply phenomenal. Yet, statistically, this had virtually no impact on the DDA.

Consider, in 1915, with a female population of 50 million (est.), there were three million live births, which resulted in 18,000 maternal deaths (and zero offset paternal deaths). If we arbitrarily assign a death age of 20 (present day is about 35) with a 1915 female life expectancy of 60, we have 40 lost life-years per maternal death totalling 720,000 lost life-years, which now need to be factored into a cohort of three billion life years (60 x 50 million). Backing out this numerically insignificant factor to the present day does not move the DDA dial one iota. This I found to be stunning, so much so that I spent hours doublechecking the stats (and my own logic). It just underscores what it takes to move the DDA dial in a cohort of 300 million.

Compare present day auto accident deaths which run about 2 to 1 male versus female. A recent stat was about 45,000 total, with a male surplus of 15,000 (30k v 15k) The DDA dial doesn't budge. Endemic is endemic and no single episodic factor is going to move this dial in a 300,000,000 cohort. Okay, fine. But we know the dial has moved steadily upward from 1920 while the cohort has grown threefold (100 to 300k). I'll share with you my thoughts as to what is driving this damn DDA in a subsequent post.

Albert

Joel Sherman MD said...

Albert, your analysis of the statistics is certainly surprising. When you compare 1920 statistics to the most recently available, how do the statistics break down? Is the growing advantage of women due mainly to them living longer? Have men's life spans decreased (I'd be very surprised)? My guess would be that women's lifespans have increased more than men's. If so, do you have any idea what other factors besides decreasing maternal mortality is involved?

Albert said...

Dr. Sherman, a realization I came to after running these numbers so many times is the coldhearted truth that social devastation and statistical worth are not connected. The social impact of 18,000 lost mothers in 1915 had to be immense, especially when this was occurring during World War I. Yet statistically it was a mere yawn. The entire OBGYN community from 1915 to 1990 is deserving of great accolades. It is this group of doctors that reduced that 18k figure to less than 300 by the mid 80s (a little less than 600 at present) while at the same time seeing a better than 33% increase in yearly births (3mil to 4mil/year). Yes, pharma and cultural attitude played a role also, but the lion's share of credit lies with the doctors, both in research and practice.

It must be kept in mind that the 1915 birthing cohort was a mere 6 percent of the 50M female cohort, and at present it is less than 3 percent. That simply is too small to move the gender gap. It gets tricky here because obviously we are dealing with a factor where less becomes more, or the old "addition by subtraction." Yet, if we were to go back to 1915 and apply present day medical standards and replace 18,000 female deaths with 600, the DDA of 2 years would not budge a month. A much deeper cohort penetration factor is needed.

And, no, Dr Sherman, there is nothing statistical out there to support that males are experiencing a reduced lifespan. Again, this gets tricky because when comparing present day male/female life expectancy and the growing gender gap (my DDA) we are now actually experiencing a "more is less" or subtraction by addition. Both sexes are living longer, much longer, but the male is living a much shorter "longer" life. Why?

Math clearly trumps science here. Math is the cold, hard, indisputable truth that all of us must accept if we are to avoid certain failure and maintain a steady progress. Science is man's quest to use knowledge and art in the hope of changing the math, not disprove it. This past century's OBGYN college did just that. They didn't deny the math, they attacked it! They totally spat upon the then accepted cultural norm that women die in childbirth. They marched on against much early criticism and ridicule borne of sexism, religion, ignorance and cultural apathy to defeat man's greatest challenge ... Mother Nature. This same dedication to changing the math in the face of great apathy and staunch reticence is what it will take if the DDA is ever going to be defeated.

And so, to answer Dr. Sherman's last question, yes. I have a very strongly held conviction, having mathematically ruled out any other factors I could think of, that the two most endemic factors that possess the greatest penetration into our 300,000,000 cohort are indeed medicine ... and diet. While diet appears to have a somewhat greater penetration into the cohort than does medicine, the actual DDA influence of diet disparity holds far less consequence than does the M/F medical disparity. I will share my feelings on what is driving this M/F medical disparity in a subsequent post.

Albert

Joel Sherman MD said...

Apropos of our discussion I note a news story just released by the census bureau documents that the age differential between men's and women's life expectancy has narrowed. Not clear why? This article quotes as a possible reason the increasing incidence of lung cancer in women.

Anonymous said...

Did anyone see the Today show on June 2? They had a segment on why men don't see a doctor as often as women. Having followed this blog, I couldn't help but notice that not only the anchor person but also the psychiatrist and the internist being interviewed were all women. Kind of odd. Of course the issue of men's possible embarrasment/modesty was not mentioned. They seemed focused on the main reason being that men did not feel it was "manly" to complain or seek a doctor's attention. The one solution they seemed to come up with was getting the women to make appointments for their mate and also to stress to the men that their health was important and keeping themselves well was the "manly" thing to do to be around to provide for their family, etc. I personally think the segment would have been more valid if they would have had men addressing the issue. But maybe they assume that mostly women watch the program at that time of day (morning) and that is the audience they target. Jean

Joel Sherman MD said...

Thanks Jean. It would be worth sending your comments to the Today Show. I'll try to find a link. I'm sure it never occurred to them that it's strange not to include a male viewpoint on the subject. And modesty and embarrassment is a subject that no one talks about; it's rare to see it even for women.

Here's kind of an original idea. Lexington KY is having a health fair for men, including such attractions as automobiles. Maybe it will help. They will have prostate screening available but of course don't mention who the examiners are or whether there will be a choice. Men may be willing to go if they are concerned about sexual dysfunction, but most don't want to talk about that with young female nurses.

Joel Sherman MD said...

Here's the link to the Today Show that Jean described. Don't know how long it will be good. Haven't found a place where you can comment directly.
Yes the show is an interview with 2 women about how to get your guy to the doctor. No attempt is made to get a male opinion. And no consideration is given to men who aren't in a relationship with a woman. I guess they don't deserve medical care then. It's almost as if you don't qualify for medical care unless you bring a woman along. That's likely too strong, but is what happens when you get a skewed view from one gender only. And no mention is made of embarrassment or modesty.

Joel Sherman MD said...

Here's a fairly nice article on reminding dad to see a physician on Father's Day. The emphasis is on prostate disease.

Joel Sherman MD said...

Here's another article on the top 5 killers of men. In order, they are heart disease, cancer, accidents, chronic lung disease, and stroke. Most of these have known risk factors which can be controlled.
Have to take advantage of these articles which are centered around Father's Day and men's health week. The rest of the year we tend not to hear much about it.

Joel Sherman MD said...

Here's an article comparing how breast and prostate cancer are treated by the media and how men tend to ignore the danger. Breast cancer awareness month was followed by prostate awareness month. Breast cancer month featured football players in pink and pink tinted newspapers as a small example of the media blitz. Prostate month was ignored by the mass media.
The article gives current figures on incidence and mortality for both cancers. They are roughly equal. No one would say that we need less publicity on breast cancer, but it amazes me how men's health issues are ignored.

Anonymous said...

I had an issue with the way I was treated.I met with my male Urologist once and he suggested a scope of my prostate because of frequent urination .I reluctantly said ok.I was nervous weeks before hand dreading the embarrassment. Second time meeting him and I was going to drop my pants and have him handle me.So I went in and was takin into the room by a female nurse and she took my info as usual.He walks and and says are you guys ready.My heart sank as I new she was going to be involved and we never met before.I could feel the blood in my face from blushing and didn't want to go through with it but felt more embarrassed asking her to leave as society says grow up and she's seen it before and don't be silly.Swallow your pride it needs to be done.Long story short I felt so embarrassed I won't go back to see him for another prescription for flomax I'm suffering.Waking up 4 to 5 times a night and having pain,I'm 41 yrs old.I'm torn between calling him and telling him it wasn't a good experience or saying nothing and finding a new Dr.I need advice.

Joel Sherman MD said...

Anon, a new physician won't automatically cure your problem. Urologists are well aware that many men are embarrassed by these procedures, but are not used to being asked to provide same gender assistants. It's time to ask and see if he will accommodate you. Possibly writing him a letter will work. If not, go elsewhere, but before the appointment again explain your problems so you won't get caught in the middle again. Chances are someone will accommodate you.
You have a problem that you can't ignore.

mmodest said...

Do male DR feel homophobic having a male nurse?Does he feel like he's not a real DR or man?Society says woman should be nurses.Is it a macho thing or power struggle or is it a domination thing.Your take on this please.I am the male with the urologist problem and would like to know why he dosent have a male nurse on hand knowing the discomfort.

Joel Sherman MD said...

mmodest, I once asked my urologist why no male assistants worked there, certainly not because the doctor is homophobic. He was fully aware that many men are embarrassed by female assistants. He said they had had male assistants in the past, but couldn't get any more. But I don't think they tried very hard.

But I had another appointment a year later. I didn't say anything, but I noted that there were 2 men working there now. So maybe my asking did make a difference, as I'm sure your asking would as well.

Anonymous said...

I think the embaressment factor you speak of is a huge part of a bigger problem. As you indicated breast cancer gets multiples the attention and funding that prostate cancer does even though the rates are similar. I recently was driving through Indianapolis and saw several billboards by one of the major hospitals adverstising an advice line for women called 4-her. I heard adverstising for the same, so when I got back to the office I emailed them and asked where I could access the men's advice line, I recieved a simple one line respones. There is no advice line for men at St. ******** . I also read an article about a man who was diagnosised with breast cancer, he made to much money to qualify for medicaid so he applied to a program provided by the government for those with breast cancer who didn;t qualify for medicaid, guess what he was turned down because he was male...can you imagine the uproar if the genders were reversed, with such blantant disregard for the double standard for men's health, why would a man expect to be treated with the same respect as women. I can tell you from personal experience and from talking to friends, knowing our modesty will not be respected, knowing we are outliers in the medical community does indeed contribute to why men do not seek medical help....and once again, thank you for the forum and the tools to help address it.....alan

Maurice Bernstein, M.D. said...

Here is the link to the story that Alan has described:
http://abcnews.go.com/Health/breast-cancer-patient-denied-medicaid-coverage-man/story?id=14241171

Though I don't know the real reason for keeping men with breast cancer out of the special breast cancer act but the fact that the act was passed and not as yet revised demonstrates another evidence of political insensitivity. Though rare, wait until a male legislator gets breast cancer. Oh.. I forgot..he most likely will be able to pay for his healthcare. ..Maurice.

Joel Sherman MD said...

Here's an updated link on that story. After substantial publicity, the State of S. Carolina has decided to pay for the treatment. They will submit the bill to Medicaid and hope they get reimbursed.

Doug Capra said...

Yes, Joel -- but notice this quote from that story:

"We believe it is in the best interest of Mr. Johnson to deem him eligible for the Medicaid Breast and Cervical Cancer Program," said Tony Keck, director of the S.C. health department, MSNBC reported."

In other words, this has nothing to do with double standards or gender discrimination. It's just that it's in the best interest of the patient. Note how they want to avoid any language that has anything to do with discrimination. The quote doesn't refer to a "class" of people, i.e. men. It's just about Mr. Johnson, one person, one individual case.
Interesting. Now let's see if the Federal Government picks up the tabe. Any guesses?

Joel Sherman MD said...

Well, you might be reading too much into it, Doug. The discriminatory standard is so obvious it hardly needs any emphasis.
I'd prefer to think that the Federal standard was just an oversight; people don't think of men in regards to breast cancer. -Just as a policy on prostate cancer wouldn't include women.
Most laws are constructed to be gender neutral, even perhaps when it makes little sense.

Doug Capra said...

I could be wrong, Joel, but I don't believe so. When politicans and lawyers (often one and the same) make statements, they choose their words carefully. It seems to me the issue they'r raising here is whether this patient represents a "class" of people, i.e. men, or whether it should be dealt with on an individual basis - i.e. this is just an individual case. If it's a "class" issue, that has implications for men regarding any law that seems to be just for women.
Anyway, it would be interesting to hear a lawyer's take on this.

Maurice Bernstein, M.D. said...

Joel, would you say that those men who fret about physical modesty in medical care represent a "class" and should be provided equal attention and treatment as women..or.. do they represent isolated statistical outliers who must be attended to only on a individual basis? ..Maurice.

Joel Sherman MD said...

Doug, the law involved was Federal as I understand it. South Carolina couldn't change it. They had to act on a case by case basis.

Maurice, there is little data available. My guess is that the number of men who are willing to complain about modesty issues are small, making them an outlier if you will. The number of men who care about it is much greater in my opinion. But the percentage of both men and women willing to complain is a distinct minority.

Doug Capra said...

Joel and Maurice:
What's often not considered in those few modesty studies is the context issue. A good study might, first, ask participants what kind of specific medical care they have had. The idea would be to get a handle on patient experience with the system and its rules. The data could be sorted on a continuum, with no experience on one end and much experience on the other. I see this as very important.
Next, partcipants would be asked how they would feel about gender and intimate care in the specific context of different kinds of care and procedures. Detailed descriptions would be given, perhaps with photographs. They'd be asked questions about gender preference, observers inclucing students, how much information they would want to know about the procedure beforehand, etc. I think the medical community assumes that either patients know the specific details of individual procedures, or that they don't want to know or don't really care one way or the other.
I think you get skewed responses if you ask people who have had little medical ecperience about their opinions in this area. They may think they feel one way or the other, but once put into the specific context, they may find themselves in an entirely different world with a radically different opinion.

Anonymous said...

I will not go to a doctor for anything involving any intimate area of my body. I've had kidney stones and ureteral stents and I've seen first hand the gender inequality in the healthcare system. I am 41 years old and if something goes wrong down there I just hope it goes away, and if it is something serious. Oh well, I've had a good run.

Joel Sherman MD said...

This article relates the screening experience in Jamaica, comparing prostate vs cervical & breast screening. Incredibly 567 men were screened in a year vs nearly 11000 women. The article states that men are reluctant to get rectal exams, but doesn't break down the reason for that. Is it homophobia, embarrassment or just a general insult to their masculinity? Interestingly the doctor interviewed is a female urologist who doesn't comment on physician/patient gender issues.
If Jamaica is like this country, the women are bombarded with never ceasing messages to get screened whereas you never hear about prostate cancer.

Doug Capra said...

"Interestingly the doctor interviewed is a female urologist who doesn't comment on physician/patient gender issues.

This is a good example of the "elephant in the room" syndrome. Quite often, what's left out of articles tells us more about people's world view than what's put in. The fact that it isn't mentioned is a statement, a statement that it isn't or shouldn't be an issue. It's an assumption.
The fact that 567 men were screened in a year vs nearly 11000 women -- indicates that gender could be a factor -- but since gender represents an elephant in the room, i.e. something that doesn't even exist, chances are it wasn't and will not even be considered as a factor.
Interesting article, Joel. Yet another example of how we human beings see what we want to see, not necessarily what's out there.

StayingFit said...

The doctor in this article really must know, even better than her male colleagues, how embarrassed men feel during a DRE. Most men are not comfortable with this test, but, for many, it is far worse when administered by a woman, or when a female assistant is present. I agree that the silence of the doctors interviewed, and of the author of the article, regarding this issue, speaks volumes.

However, I predict that, were someone to make a comment on this article, regarding discomfort with the presence of women during the exam, there would be two types of responses. The first would be to accuse the commenter of being gay, and the second to accuse him of being a wimp who should “suck it up” and get tested. Both of these responses would come not from women, but from other men. Very likely, many of these same men would feel similar discomfort, but would never admit it.

It's a shame that men are reluctant to be honest about this. But, it is even worse that other men will not support them when they are.

I do agree with the article, where it states that the approaches normally used to encourage men to be tested, have failed. I remember one such failure in the US, which was the “don't die of embarrassment” campaign. Here, men were basically told to “get over” their discomfort and get tested.

I applaud that campaign for at least acknowledging that embarrassment is an important factor in explaining why men avoid these tests. However, I wonder if it would not have been much more effective, had it listed the ways that the embarrassment could be minimized. Things like telling men that no nurse or “assistant” need be present, that it isn't sexist if they feel more comfortable being examined by a male physician, etc. Basically, had the sponsors shown sensitivity to the modesty of men, and then happily offered to work with them to minimize their discomfort, would this campaign have been more successful?

I believe that the medical profession in the US, in Jamaica, or wherever else, must acknowledge and act upon that which it already knows, regarding the reasons that men avoid these tests, even if this means admitting that gender neutrality in medicine has its limits. Until they do, all of this hand-wringing over the reluctance of men to be tested is little more than theater. Men, as a group, aren't likely to change any time soon, so medicine has to. Otherwise, as the saying goes, “if you want to keep getting what you're getting, keep doing what you're doing”.

Joel Sherman MD said...

I've been meaning to second StayingFit's comments that more would be accomplished in prostate cancer prevention campaigns if they recognized that some men have modesty concerns. No one seems to bring it up except for these few blogs.
Occasionally you see offered prostate screening clinics run totally by female nurses. It makes little sense. If you ever see such a clinic being advertised, I recommend you call and ask if male examiners are available.

Anonymous said...

I totally agree with Staying Fit. If the medical world wants to improve screening statistics/targets, they should make an effort to address modesty issues and not just brush them off with "it's important to have the exam, we are professionals and are used to doing this, don't die of embarrassment, get over it, etc." There is a lot that can be done to accommodate both genders in screening tests to address modesty concerns, for instance, offer same gender teams, offer disposable colonoscopy shorts, make the patient more of a participant with choices and more information, etc. I think taking this tactic would greatly improve screening numbers for both men and women in any number of exams. And I don't believe that it would bother anyone who does not have modesty issues to at least be offered these options. If anyone can see what I mean: more people would be happy and those with no opinion would still be at the same place. Why hasn't the medical community bothered to take this stance? Money, indifference, unawareness of the issue(which I doubt) or a combination all. Jean

Joel Sherman MD said...

Here's a brief summary of a to be published article in the American Journal of Men's Health talking about men's reluctance to get cancer screening.
Not surprisingly one of the points mentioned is that all the emphasis on screening is for breast cancer and there is no governmental push to publicize male awareness of screening opportunities.

Doug Capra said...

Good find, Joel. But note this paragraph: " Most of the participants were aged 30 to 59, and 35 percent of them were men."
35% men. 65% women. Now, it's possible that men are more reluctant to take surveys like this and refused. But there needs to be more conscious attempts to reach men for these surveys and ask the right questions. I know it's easier and cheaper to do telephone surveys. The best studies are those that actually gather men together, all men, in groups and ask questions and encourage discussion -- if you really want to get the answers. I think too many in the medical arena already think they know why men don't go to the doctor as much as women, or why they don't get cancer screening. Thus, the surveys are centered around what they think they already know and thus tend to confirm that. I can think of several kinds of studies, methods, much more time consuming and expensive -- that would give researchers a better idea of what men are really thinking. I've seen some of these kinds of studies done in other areas with much success.
I do think education is important. There needs to be more education for men. But frankly, medicine today generally doesn't market toward men, and I believe a significant number of men don't find the medical atmosphere friendly toward them, esp. if they must go through intimate, invasive procedures. If the medical community wants answers about how men feel, the need to ask the right questions. And I don't think surveys like this ask the right questions.

Joel Sherman MD said...

Doug, I'm sure you're right that this is not the best survey. I'll reserve final judgement until the article is published which apparently won't be for awhile.
I didn't even know that there was a journal of men's health; the subject gets so little attention. It's published quarterly only. I'm sure that compares very poorly to the number of journals concerned with women's health, excluding Ob-Gyne and Urology.

Maurice Bernstein, M.D. said...

I present a possible current explanation of the issue in discussion here. Which issue?

Well, of course, the ongoing controversy between the medical profession and the U.S. Preventive Services Task Force decision regarding the male screening with the PSA test for prostate cancer is certainly no help to encourage men to screen for cancer in general. After all, if the government knocks down one "medically accepted testing procedure", what about the next? Oh, yea..the men can also point to the change in the federal philosophy vs science regarding when to start mammograms in women. All this conflict with established protocols will lead men to wonder. ..Maurice.

Doug Capra said...

I've learned over the years that the key to evening coming close to reaching the "truth," is asking the right questions. When I actually go to the studies and study them, too often I find that, IMO they're not asking the right questions. For example, with medical modesty issue, I believe the researchers must be able to divide those questioned into categories based upon how much experience they've had within the system and how much of that involved intimate procedures or exams. People who are asked how they would react to something they have never experienced, are dealing with theory. People who are asked how they will deal in the future with experiences they have had will based their answer on realistic experience. I've never found a study that did that. I recently read an article on KevinMD about the therapeutic value of touch during medical exams. It was a good article and quite valid, and the response were good, too. But no one mentioned the role gender might play in this issue, as if it plays no role for anyone. In other words, it's the question that isn't asked.
So, I guess I'm saying that I just don't trust most studies anymore unless I can study the protocol and the questions asked.

Anonymous said...

I think when male patients have been humiliated by female healthcare workers their entire lives, not trusting healthcare workers seems to become a sixth sense. Medical professionals don't seem to understand that men being stripped and fondled by female nurses and assistants is very different than women being treated by male doctors.

Maybe when 92% of female patients are told to strip and allow their privates to be seen and touched by multiple male nurses and assistants before, during and after seeing a doctor they might begin to understand why men avoid medical care. If 95% of the gynocology nurses and assistants were men, I would bet that a much smaller percentage of women would regularly go in for examinations.

For me personally, the gender of my doctor when I need to be undressed or talk about very personal health problems is very important. But the gender of the nurses and assistants is vastly more important. I don't believe that anyone but doctors are true medical professionals. All the rest are just assistants. Being seen undressed by male nurses and orderlies for me isn't much different than changing my clothes in the male locker room at the gym. But undressing for non-professional women (I'm not married to), which includes nurses and medical assistants, is wrong.

I would like to hear from women that have been in our shoes. If there are any women out there that have had 95% of their medical nudity in front of male assistants throughout their entire life, I'll bet they aren't stumped as to why men avoid healthcare. They would understand.

Anonymous said...

If you are a male patient then there is a good chance
your history, x-ray or some other private information
will end up on facebook.

PT

Anonymous said...

I recently had treatment for kidney stones, and encountered this topic. The main thing about female doctors and nurses that bothers me is their often flippant attitude to male genitalia. I don't mind being exposed for examination, but I hate the CONSTANT remark "Oh don't worry, I've seen it all. . ." as if the hundreds of nude men she's seen is supposed to comfort me.

After my kidney procedure I balked at having a catheter inserted, and the nurse remarked, "Oh I've done lots of these, it's not brain surgery." Fortunately it turned out not to be necessary.

What I find offensive is when female nurses and doctors dismiss my anxiety as infantile, often with some belittling remark, as if I am wrong for being nervous about having a probe inserted into my penis while fully conscious.

I was close to a serious anxiety episode just last week when I had to have the urethral stent removed. Here I was very fortunate. The urologist --- female --- was quite understanding of my stress. But it was the attending nurse (also female) who
dealt with most of my fear. I told her of my disgust at the cavalier attitudes I sometimes encountered, and she agreed with me. As she prepared me for the procedure she listened to all my concerns, and explained, without ridicule, exactly what would happen.

Of the three people present, two were female. Their simple acceptance of my stress, and their respectful response to my fears, reduced my anxiety greatly and made an unpleasant experience at least managable.

More of this is needed.

Doug Capra said...

It also wouldn't hurt if they asked if you'd feel more comfortable with a male nurse. Most often, they will not. It's embedded in the medical culture that female nurses can do everything to both male and female patients -- but male nurses must be cautious. It's the "entitlement" attitude that bothers a significant number of men.
I would suggest that by just asking men their gender preference, they would show their concern for potential patient feelings and dignity.
How would they have responded if you had asked to have a male do the procedure?

Anonymous said...

Personally I prefer a feminine touch DOWN THERE, over a male... but still cannot initiate the request, to have to remove my clothing... It doesn't matter what the medical staff says they see... or how they say they see IT... it's the perception of the person being examined... how HE feels being seen naked! I give you this example... actually happened!
To the Medical Doctor IN CHARGE:

I’m beginning to wonder what your people do while unsupervised in your facility.

I’m a 61 yr old male, returning to work from a shoulder injury. My company, decreed I needed D.O.T. re-certification, prior to returning to my driving duties.

Never had BP problems – Just had surgery – you’d think someone would have found a BP problem before surgery… HUH?

Doctors Don’t Care--- Men DO!
I’ll simply state, that I had a SHOULDER injury! Standing before a man stark naked, and having ones legs spread shoulder width apart, with those silly shorts at my knees, him bending at the waist and looking under my scrotum… is just too much. Where does the “Angle of ones Dangle” have anything to do with Trucking and a SHOULDER injury?
A hernia check is easily accomplished by lowering ones shorts to the base of the penile extrusion (along the big red line), and pressing fingers (Palpate) up into the pubic region [the deep inguinal ring is situated midway between the anterior superior iliac spine and the pubic symphysis], as the male patient coughs in either direction. No male genital exposure is necessary in the initial exam… except to please the sick perversions of the examiner.
Remember this is not an annual physical by the CVM Driver’s family doctor or Personal Physician. It is merely a certification that the CMV Driver is not on any drugs, and FIT to operate a Commercial Motor Vehicle.
To go as far as your PA-C went, is too sick! Like I said, I have been examined for D.O.T. Physicals all over the USA… NONE have ever treated this Truck Driver so pervertedly.
The PA-C alluded that I may have high BP when I get excited, and therefore may suffer from high BP.
Well… being THREATENED by a PA-C, with the loss of my livelihood, is a sure cause for HIGH BP!
If what I’ve read, researching this, is true… then your PA-C has just done, what two years in combat could not… shorten my life!
If each episode of high BP damages the blood vessels and shortens ones life… my return to be examined by this person, might just KILL me.
If… what I just wrote is true, then if not for required physicals, I wouldn’t have a medical problem. I never get sick… seldom get injured, and treat simple ailments myself. I avoid the medical profession like the Black Plague itself… mostly because of personal indignities, like this PA-C inflicts on men and women.
My company assigned a roommate, for the night following the indignant assault upon my person, at your facility… he just happened to have a BP cuff… put it on my arm, and I had a 140/89… not bad for a person with supposed stage three… HIGH BP!

Stop the disrespect of the patient… doctors shouldn’t have to dredge up such indignities…

Try this to improve your communication effectiveness… Explain WHY you need to visually see anything private, personal, and protected on every man and woman’s body… tell the driver what you are looking for… and why the need to observe and or touch this area, and how it is required by D.O.T. (IF it is required).
The CMV Driver might just relax and give the examiner the control he/she requests without the stress and high blood pressure.

Finally, I wonder… if this person takes this degree of liberty of indignity upon males… just what does he do to the ladies?

I had to crop a lot of this out.

StayingFit said...

"Explain WHY you need to visually see anything private, personal, and protected on every man and woman’s body… tell the driver what you are looking for… and why the need to observe and or touch this area, and how it is required by D.O.T. (IF it is required)."

Anon, I think that you touch on the issue that pervades every post on this site. Even people who are not particularly troubled by exposure, in a medical situation, ARE troubled when they are not treated with respect. By not explaining what was going to happen, and why it was necessary, you were treated most disrespectfully. When done in the context of an intimate examination, this borders on assault.

I also agree that there is no connection between such an examination, and a determination that you are fit to return to work, after shoulder surgery. It may be that the examiner thought that he was doing you a favor, by checking for issues unrelated to your surgery. If so, he could have let you know, and then asked if you wanted to proceed. Since he did not ask, he was being extremely paternalistic.

If he was just doing what the DOT requires, then he should have told you so.

No matter his motives, your examiner did not treat you as an adult, and as an equal partner in your healthcare. Instead, he behaved, as so many do, as if he was entitled to examine you to whatever degree, and in whatever fashion, that he chose.

Judging by the manner in which your post was written, you sent a note to the clinic, where this examination was performed. Am I correct? If so, I applaud your efforts, and I hope that it will result in real change.

It's a shame, since such a situation cannot be good for the examiner, or for the clinic, and you will remember this event for the rest of your life. All of which could have been avoided, if you had been treated with basic courtesy and respect.

Anonymous said...

I recently sent the following letter to my Urologist (Part 1).

Dr. Xxxxxxxxxx,

Based upon our brief discussion during my appointment, it's apparent you don't understand completely what transpired and how strongly I feel. While you're not responsible, you do set office policy hence this letter.

I was referred to Dr. Xxxxxx in 2001 for urinary urgency and frequency. The medical care I received effectively addressed my symptoms and is sincerely appreciated. Recently, the symptoms have worsened and can be professionally awkward. As an airline pilot flying internationally, I'm exposed to more radiation on an annual basis than nuclear plant workers. Cancer, of any type, is a concern. While I've received PSA tests annually, my last DRE was during my 2005 USAF retirement physical. Finally, a close friend was diagnosed with prostate cancer (2010) and recently a family member, prompting the follow-up appointment with Dr. Xxxxxx.

Caroline asked why I needed the appointment. I clearly stated that I had seen Dr. Xxxxxx before for urinary symptoms and needed a follow-up for the same reason. For a returning patient, that wasn't sufficient. To "schedule the appropriate appointment," she asked what my symptoms were. I replied "I'm not comfortable discussing them with you." This should have immediately stopped any further inquiry. Instead, she laughed and in a condescending tone said she "had heard it all before." What she may have heard before is simply not relevant. The sense of entitlement, in words and tone, and laughing at my reluctance speaks volumes. I was coerced into sharing intimate details for a 15 minute appointment and deeply resent it!

What's difficult about simple tact and empathy; basic human dignity? For example, "I completely understand. If you like, you can talk with a nurse or I'll schedule the standard office visit, whichever you prefer." Such dialogue clearly establishes my limits are respected and offers reasonable alternatives. If the genders were reversed, I doubt similar complaints by a female patient would be ignored.

Dr. Xxxxxx was dismissive when I mentioned this. Frankly, when I raise an issue with my physician, I expect a sincere response. We can agree to disagree, but only after the issue has been discussed completely and professionally. I spoke with your office manager, who by the way really seems to get it. She asked if I wanted to discuss this with Dr. Xxxxxx and replied yes. She asked if I wanted to change physicians and if I had a preference for a male or female urologist. That's how I ended up as your patient. I never heard back from Dr. Xxxxxx.

During the ensuing appointment, if understood correctly, you implied the receptionist acted appropriately. Really, then rationally justify her words and tone? Explain why my stated reason for requesting an appointment was insufficient? Why wasn't my clearly stated reluctance respected? Not wanting this issue to detract from the appointment, I replied simply I'm not comfortable discussing my symptoms' with your receptionist.

Joel Sherman MD said...

Anon, your complaint is certainly valid to my mind. I see a urologist annually and the receptionist has never asked for the reason. I can't believe that they have a pressing reason to insist on asking. Generalities should be more than sufficient. The urologist cannot schedule anything without seeing you personally. When my wife sees a gynecologist, they only want to know whether it's a routine checkup or not. If not they don't push for details.
But in any event there is no excuse for the rudeness of the receptionist and the physician himself. Feel free to go elsewhere and tell your urologist why in your letter.

Anonymous said...

Urologist Letter (Part 2)

An effective doctor patient relationship is based on trust and mutual respect. A medical practice that ignores a patient's reluctance to speak with ancillary staff about intimate symptoms is troubling. A urology practice doubly so! While you and your staff may consider our health issues routine, I'm confident most urology patients don't and I certainly do not.

Treating people with dignity and respect is not rocket science. Your receptionist was blatantly disrespectful and unprofessional! I am the PATIENT and paying customer; the apology is overdue. I expect professional care that respects my values, beliefs, privacy, and dignity. Ironically, your "Patient Bill of Rights" states the same.

Very Respectfully,

//signed//

Anonymous said...

It's so relieving to see that I am not the only one who feels this way when I go to medical appointments. If the hospitals were staffed with 95% men I have no doubt women would be crying bloody murder. I can't beleive that it's not even addressed in the news if that many people are choosing not to seek medical care. As I said if this were the case for women it would be taken care of right away. It's balatant proof that we have a government that has no sense of equality. But that's already obvious isn,t it?

Anonymous said...

You are definitely not alone; studies show that 50-70% feel the way we do.

Anonymous said...

While this doesn't answer Dr Bernstein's question with respect to physician gender preferences, it clearly shows male athletes prefer male providers for male health issues.

http://www.sciencedaily.com/releases/2010/07/100713122842.htm

Ed

Anonymous said...

Here is a better link with what apppears to be the complete study.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1896076/

Joel Sherman MD said...

Thanks for the reference Ed. It is definitely of interest. I'll see if I can get the original article to get the details.

Joel Sherman MD said...

That article you gave Ed also has more references. Here's a similar reference on the same subject.

Joel Sherman MD said...

Here's a nice article on getting men involved in their medical care, a Cincinnati project.
I'm sure more men would get involved with their care if the matter was given anywhere near as much attention as is given to women's health.

Maurice Bernstein, M.D. said...

Joel, this may not turn out to be a significant observation about your linked article, but notice that the writer was not a man but a woman! But if significant, might this not raise a generalization or even a possiblity that men, not only seem to be less involved in reading and acting about their life's medical risks, diagnosis and treatments but might also be less interested in reporting that observation.

In any event, the article is a good reminder of what is likely a true gender disparity both in gender interest in personal medical attention but also to gender attention by the medical community.
..Maurice.

Anonymous said...

I agree its a step in the right direction but it fails to address one of the fundamental reasons why a significant percentage of men avoid medical care and that's opposite gender care of an intimate nature. To comment you need to be a Facebook user; I'm not.

Ed

Joel Sherman MD said...

Maurice, I'm not clear from the article whether a man or woman is behind the initiative, both are mentioned. I note that the funds from this program come from a family grant not specifically directed at men. This article is noteworthy only because there are so few initiatives directed at men. For women articles like this appear every day.
I think to reach men health articles should be included on the sports pages, just like woman's health is in the women's pages.

Maurice Bernstein, M.D. said...

Joel, It was my fault for your confusion. I was writing strictly about the writer of the news article, identified as Krista Ramsey presumably a woman but I was trying to extend this observation into a unlikely generalization about the gender of writers of men's health topics. However, such a civic initiative as described in this article should be applauded and encouraged to be spread to other cities. ..Maurice.

Anonymous said...

F A P disease has been the reason of most of my medical appointments,requesting male nurses to reduce my embarrassment has been a waste of time,it even results in female nurses being obvipusly resemtful towards me during during my last appointment. I have not kept an appointment for needed care since then. That alpng with unnecessary genital exposure in front of female medical students,surgical errors and having been very shy all my life...being diagnosed with PTSS as a result of medical conditions and medical errors. Medical attentipn is now something that has too many negative ''ingredients.'' I've realized that a healthcare givers all onclude their attitude in caring for patients. And the attitudes in care for me have bee verry compassionate sometimes ,others have been resentfull,and down righr rude. My future medical care ...it's going to be neglective and at best rare.

Maurice Bernstein, M.D. said...

Familial adenomatous polyposis can lead to early onset colon cancer and death. Hopefully, the last poster, Anonymous, will reconsider the decisions against undergoing monitoring for polyp removal and cancer. How about the procedure performed under sufficient anesthesia to assure amnesia of the event and the absence of female assistants while the patient is awake? ..Maurice.

Anonymous said...

I'm the male f a p patient that's felt too much embarrassment from so much of my body being seen by female caregivers and students. Even the times I've been completely under from anesthesia, I know the females , ? how many ?, Saw all of me. That is ''to me'' humiliating. I only get to talk to females on the phone when asking for all male care for procedures. That's embarrassing too. Even males will make me feel embarrassed...just not as much. Getting all male care obviously isn't going to happen. There isn't much at all being done in hospitals to show that they care that same gender care may be the only way some patients will make and keep appointments that they need. Sometimes humility or embarrassment get to where it has to be kept out of medical care.

Maurice Bernstein, M.D. said...

In 2 days, I am going to participate in a 2nd year medical student workshop in which the students practice on plastic models the male genital examination. Later, they will practice on human teacher-subjects. What do the visitors here suggest I instruct the students with regard to any declaration or question to the male patient prior to actually "laying on of hands" on the patient's genitals? ..Maurice

Anonymous said...

Im the f a p patient thats felt too much embarrassment. Maybe my situatoon is unusual. My medocal caseanager amd I had a lengthy discission about how I feel threatened from poor medical care during the past 11 years. I was telling her all about errors made in my care and she admitted they were very numerous,then at the end of our talk,she told me to expect mistakes to happen with all my appointments,???? Suddenly healthcare became my enemy,so to speak. All the medical errors that happened to me were all by female caregivers,except for one. My dislike for female care is severe. 3 times females gave me mrsa that twice nearly ennded my life. It was a female that put me through 3 pet CT scans in 3 hours to get propper images...far too much radiation that I now know causes cancer ...even moreso on f a p patients. It was a female that tripped and stepped on my cathater tubing as a female nurse was holding it too low as I was on my feet for the first time after my colon was removed. It was 3 female med students that looked at me totally nude and unable to cover myself.It was a female that assisted with my flexible sigmoidoscopy and took biopsies as my bowel was collapsed,she could have cut through the bowel wall and I would have needed major surgery . Then an administrative female denied anything inappropriate when I filed my complaint with the hospital quality of care nurse.I watched the procedure on the monitor as I refused unnecessary anesthesia. It was a female nurse that confused my charts with those of a dismissed patient and gave me that patient's injections. There is more , Now isn't it obvious why I dislike ,refuse and actually HATE medical care from females. a psychoatrist treatimge diagnosed me with ptss from medical conditions and medical errors,then he told me it would cost much more to treat me than my insurance would agree to cover. I left and didn't return. Signed ''W H Y''

Anonymous said...

Maybe secretly it's a way of saving money on health care so it can be spent on women's clinics. I have had what I assume is prostate symptoms for the last 5 years. I don't go to my doctor because I know there will be a whole pile of tests ordered. I know women will be performing or assisting with them and that bothers me big time. I will just live with the problems and if I die from them at least I will have lived a few extra years without the embarrasment.

Joel Sherman MD said...

Here's a potentially important article from the NY Times blog concerning what they term a growing trend in health care, male centered clinics.
Good news if it really becomes established.

Maurice Bernstein, M.D. said...

From the article, don't you get the impression that attention is to doing things for "health" and even though physicians are virtually all male, there is no mention that male physical modesty "embarrassment" issues play a major role in avoidance by males going to doctors.
It seems more likely that males go to this clinic because it is oriented to male disorder 'needs". ..Maurice.

Joel Sherman MD said...

Dr B, clearly the article does not mention modesty and the clinics don't seem to stress that. It's hardly a surprise.
But they do suggest that they sensitively treat male issues which is not identical but similarly themed. I'm not sure that stressing modesty would be the right approach for most men.
Men with ED or similar issues are likely embarrassed more by the condition itself. I have no idea if any of the clinics routinely use female nurses for intimate procedures or exams but if that's the patient's concern, I'm sure they would be more understanding than the average clinic.

Doug Capra said...

At the end of the article, this comment:
"But he conceded, “For a sexual issue, I guess I’d like to talk to a man.”
The implication is that modesty is a consideration. What I find interesting is that hospitals are afraid or hesitant to use the word modesty or imply that gender choice is an issue with some or many patients. It's the elephant in the room. They skip all around it. But if you read between the lines, it's there.
I'm sure they have female staff, and why not. For some men it doesn't matter. But I'm convinced that a man who wanted an all male staff could get it at these places.

StayingFit said...

Interesting article here. In discussing why men don't visit doctors, the author mentions some issues that have been discussed on this blog. Most notably, he states "Most men dread a visit to the doctor because it is often a cursory drive by physical that ends in a list of things they should not do. That, combined with the nearly universal all female ancillary staff, from the receptionist who insists we share the most intimate details of our lives as a prerequisite for an appointment, to the tech, seldom medical assistant, who records those same details in our records, all prior to even seeing the doctor for 10 minutes. Given the extremely personal nature of men’s health care and the potential for embarrassment, why is privacy and dignity so callously disregarded on a routine basis for male patients? How would female patients feel if their OB/GYN was accompanied by a male assistant or chaperon barely out of high school. This double standard needs to change for men to feel comfortable in seeking health-care."

He then states "I’m convinced a significant percentage avoid needed medical care for this exact issue."!

What's even more amazing is that the is NP seems to represent a company in Manhattan called "Metro Medical Direct". Their website is here. On that official website, they state "The most common reason men do not seek health care services is because it is seen as too time consuming, feminized, and highly inconvenient.".

Maybe there is hope, after all?

Joel Sherman MD said...

Thanks StayingFit. Although the article is an inducement to visit their clinic, it is well expressed and does indeed include many of our thoughts.
The oftener these thoughts appear in print, the more likely it is that these ideas will achieve a more universal acceptance both by providers and patients.

Maurice Bernstein, M.D. said...

I would agree with Joel that, unfortunately, this is also an advertisement and one has to consider the expression (perhaps not the content} is one to promote the clinic's self-interest. But as we all know, there are problems dealing with male care. ..Maurice.

Joel Sherman MD said...

Male only clinics are clearly becoming more acceptable and widespread. Coincidentally just today there was an ad in my local paper for a clinic for men specializing in ED disorders. Here is their website. This is very definitely not an endorsement for this apparently national chain which has a misleading name which suggests erroneously that they're part of a major university. But of major interest to me both their ad in the paper and their website (under privacy heading) claims to have an all male staff.
Same gender staff to treat men is becoming acceptable.

StayingFit said...

I agree that it is an advertisement, Dr. Bernstein, but that does not detract from its significance. In fact, I think it adds to it. Clearly, this company believes that there are men who have modesty issues, and they see a business opportunity in meeting the needs of these men. The healthcare industry is much more likely to respond to the modesty concerns of patients, if they believe that it is in their self-interest to do so. Therefore, I am actually encouraged that these issues are discussed as part of an advertising campaign. It shows that some businesses not only recognize these concerns, but are willing to acknowledge them publicly, and to design a business model around them. This is all the more remarkable, given that it is specific to male modesty, which usually elicits ridicule in other areas of society.