by Joel Sherman MDThis 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.
