Monday, November 24, 2014

Masculinity and Men's Health

Masculinity and Men’s Health Care
Doug Capra

            What does it mean to be a man? How do we define masculinity? What does a “manly” man look like, sound like? How does a real man behave?
            More importantly, who gets to decide the answers to these questions?
            The Movember Foundation is a respected global organization committed to changing the face of men’s health care.
How? By challenging men.  They challenge men to grow mustaches during November to raise funds and open up dialogue about prostate cancer, testicular cancer, and mental health issues. Since 2004, they have raised over $550 million and have funded over 800 programs in 21 countries. They are an honorable organization.
That’s why I was surprised recently to read a press release promoting this mustache-growing event that contained the following sentence:
“Most men aren’t proactive about their health because they’re ill-informed, lazy or scared. And that’s not manly.”
I’m not questioning the intent of the article. Getting more men to be more proactive about their health is an exemplary goal. But calling men lazy and unmanly?   And how dare a real man be scared. Real men aren’t supposed to be scared, are we? If we are, we’re certainly not supposed to verbalize it or show it in any way. On the other hand, realistically, who wouldn’t be afraid of the possibility of prostate or testicular cancer?
I couldn’t imagine this kind of language being used when the pink ribbons are distributed and women are urged to get checked for breast cancer? Why then do some believe it’s acceptable to use this language to convince men to get health care?
I immediately checked the Movember Foundation website  and read through it. I first went to their visions, values and results section under “about us.”  Everything I read showed tremendous respect for men, so I couldn’t imagine this language coming out of the Movember Foundation. So I sent an email to Movember inform them about this incident and asking if the press release came from them. I immediately got an email back from their representative, Abbie Rumery. She wrote:
“Thank you so much for reaching out. Was this a press release that was put out by a local community group, or was it in a news article that you read? That is not something we would ever say or promote on our website. Movember is all about getting guys to feel more comfortable talking about their health and breaking down stigmas and barriers related to their physical and mental well-being. If any organization is looking to promote their involvement in the Movember campaign, I would normally send them this digital press kit and the attached one pager and press release template. None of which say anything about men not being proactive about their health because they are lazy or scared and that it’s not manly.”
I hadn’t thought those words came from the Movember Foundation. That wasn’t their style. But then – where did that press release come from? I eventually found out, and I was further disappointed
I learned that what appears to be the original article is on a website belonging to the UMC Health System. They claim to be “the leader in comprehensive healthcare delivery in West Texas and Eastern New Mexico.” They say they reach “more than 300,000 patients a year,” patients that have “come to expect our dedication to service and the top-tier care we provide.” I’m not certain that this article originated there; it could have been reproduced from another source. But that’s not an excuse.
I sent an email addressed to four of UMC Health System’s top officials. I’ve not gotten an answer back from them and I note as I write this that the link that contains the sentence about men being lazy and unmanly is still up. You can find it here.   The fact that they haven’t returned my email is also disturbing. By ignoring controversies you just raise more disturbing questions. Did they think my email was from a crank? Do they consider my complaint unjustified or irrelevant? Or do they really believe that many men don’t get health care because they’re lazy and unmanly? By not facing the issue, they leave these questions unanswered.
I’m one of the men who is proactive about his health, and although I’m not a health care professional, I’m actively involved with health care issues. I frequently urge men who aren’t as proactive as I am to get checkups. But let me suggest that there are better ways to persuade them than by calling them “lazy”-- and saying that being afraid – a reasonable response to serious disease – is “unmanly.” Yes, many men are uninformed about health care issues – but not more than the population in general.
The real question – that is rarely asked and rarely researched – is actually why these men (and some women) don’t seek healthcare. And let’s not leave out that high costs may be one reason. Even with insurance, some patients can’t afford the deductibles.
Catherine E. Dube, EdD, has been doing research into men’s health attitudes for years. She and her colleagues published “Talking with male patients about cancer screening” in the Dec. 17, 2004 issue of the Journal of the American Academy of Physician Assistants. They wrote:
“Clinicians may hold certain assumptions about male patients that are not well founded. Clinicians may believe, for example, that men are immodest and unlikely to feel embarrassment during genital exams, don’t care about their health, are emotionally insensitive, and will seek medical care only if pressed to do so by a woman in their life. In our focus group research, however, we discovered that men were surprisingly modest about physical exposure in clinical settings, concerned about embarrassing exams, and interested in their health. We also learned that they desired closer personal relationships with their health care providers.”
This can be a sensitive issue that is worthy of much more discussion than I have time or space to offer here. Dube and her colleagues also wrote:
            “Understanding male communication and behaviors has become even more important with women entering the health professions at ever increasing numbers. Stereotypes held by practicing clinicians and handed down to trainees need to be challenged and adjusted to provide more effective care to men. Since men are less likely to be connected with the health care system than women, special efforts should be made to encourage appropriate preventive care, including age-appropriate cancer screening and early detection strategies.”
This article was published ten years ago, and perhaps we have made some progress – but not nearly enough. Indeed, the health care system is under even more stress today than it was then. Rising costs place a tremendous stress on efficiency. Safety, quality, standardization and patient experience issues dominate many a discussion in medical boardrooms.
And patient experience is an especially hot topic today. Some experts in customer service will tell you that the medical community, generally speaking, is twenty-years behind the times. In the early 1990’s a team from the Harvard Business School, Pine and Gilmore, published a book called The Experience Economy. Consumers were not merely after food or coffee or beer, they contended. They wanted an experience. That’s what they would pay for. They pointed out how Starbucks turned a commodity into a successful experience. Disney may have started the movement, or at least perfected it – but other businesses followed.
The patient experience begins with the patient’s first encounter with the system.
At the end of their book, Pine and Gilmore said that the experience economy has already peaked and we’re moving into what they called the Transformation Economy. Consumers don’t just want experiences, they want peak experiences that will transform their lives. We see that today especially in the tourism industry.
As we’ve consistently pointed out on this website, medical modesty and privacy are extremely important values for some patients and very important for many others. We’re not claiming that most or all men who avoid health care do it for modesty reasons – but certainly some do – as do some women. One of the key elements of American capitalism is choice. Patients in general, both men and women, should be offered the caregiver gender they feel most comfortable with, especially for the most sensitive exams and procedures. This may be one reason why some men and women don’t seek the care they need.
Certainly, we can push people into all kinds of behaviors by using name-calling and guilt. But that’s not persuasion. At its best it’s intimidation. At it’s worst it’s bullying. Of course, if one believes that the end justifies the means, than I suppose anything goes.
But the idea is to create lasting change, a “transformation,” -- not just one visit to the clinic where the experience may or may not be positive. The idea is to get rid of sexist stereotypes in both language and practice and start dealing with reality. Most men at heart want to stay healthy, not just for themselves but for their families as well. They may be afraid, but that’s natural. They may be strongly influenced by masculine stereotypes themselves and feel they can’t be afraid or embarrassed, or express their true feelings to health care providers. Certainly, telling them that this fear makes them “unmanly” is counterproductive and plain wrong.
But we’re not only dealing with the stereotyped attitudes some men may have been raised with.  We’re also dealing with attitudes from the medical community as Catherine Dube points out in her research.
As the month of November ends, let’s not drop the issue of men’s health. Let’s keep it open. And let’s all of us start taking openly about the issues that prevent men and women from seeking the health care they need to better their lives and those they love.