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Men, it's time for a checkup

July 23, 2006 12:50 am

THERE'S A GROUP of patients who are more likely to have high blood pressure and heart disease at a young age, more likely to have sleep problems, stress problems and substance abuse problems, more likely to engage in risky sexual practices, suffer chronic diseases and occupational injuries and have a poorer diet--but are less likely to go to the doctor.

They are called men.

Surveys show that men studiously avoid going to the doctor, despite such sobering statistics as the fact that they are 2 times more likely than women to have a heart attack before age 65. A third of men that age or older have high blood pressure. But they soldier on in their macho oblivion, making 150 million fewer visits to the doctor per year than women.

There are claims that this starts at an early age. That education at school is directed at reproductive health, gives more emphasis to female issues, and doesn't teach males the importance of health monitoring and checkups. Then around puberty "things really diverge," notes Dr. John W. Saultz, professor and chairman of family medicine at Oregon Health Sciences University, in an interview for WebMD.com. Females get sucked into preventive health care by virtue of regular Pap smears and gynecological exams and "establish a lifelong pattern," but men "are left to their own devices," Saultz says.

Also, young males tend to have that teenage invincibility. They smoke, they drink, they indulge in risky sports/sex/occupations and often eat a terrible diet. They are oblivious or uncaring that they are laying the foundations for ill health in later years, instead of going for regular checkups, where they could be assessed for risk factors for diseases and be counseled about diet, weight control, smoking and exercise.

There is more to it than just obliviousness, however. As these wild and rambunctious males age, they usually hear from somewhere or other that they should be taking care of their health.

A not uncommon source of motivation for these reluctant men is their wives. It's not unusual to have some sheepish-looking guy in for his annual physical as a "honey do."

But still, men falter.

Studies in the U.S., England and Australia of this thorny problem have noted several impediments to men's taking care of themselves. One is the matter of preventive health services in general being more directed at women and children than at men, and of doctors' offices being "feminized."

Maybe we need to start playing NFL reruns on the waiting-room TV instead of "Chicken Run"?

What seems to be a major issue is men's masculinity, according to a survey conducted by the American Medical Association in 1990.

It seems a little bit the same issue as men not asking directions. I have this image of some Jeff Foxworthy heavy-equipment operator, undershirt stretched over his beer gut, Budweiser and Marlboro in hand, who is in no hurry to be upbraided by the doctor for his bad habits, or to have his prostate checked--the "grand finale" of the physical, as I like to quip with my patients. These guys seem to feel so much embarrassment at this ultimate surrender/indignity that I tell them about the maxim we were taught in medical school, "If you don't put your finger in it, you'll put your foot in it," in the hopes of defusing the discomfort.

Along with seeming embarrassed, men also appear to be more in denial, and more fearful of the consequences of visiting the doctor.

"Unless they're in crisis, many of them will soldier on," notes one author of a survey of 44,000 general practitioners in Australia on men's health. (GPs there are the equivalent of family physicians here.) This survey, and one in the U.K. performed by the Men's Health Forum, seem to show that avoiding the doctor is not just an American phenomenon. Those rough, tough Australian men and their U.K. counterparts seem to be just as averse to doctors.

Another issue is that going to the doctor and being diagnosed with coronary heart disease is one thing, but much harder to take for the macho man is being diagnosed with some stress disease.

Anxiety to some extent--but depression in particular--is so often seen as some kind of wimpiness. This is particularly threatening to the self-esteem. The stats show men are more likely to suffer stress diseases than women, but on average only 20 percent of participants in stress-management classes are men.

The surveys about men don't differentiate between socioeconomic categories, and I don't want to imply that white-collar men are any better than the stereotype I am invoking. Among men in general, three out of four don't know how to do a testicular self exam (to screen for testicular cancer). And of the 50 million Americans who have high blood pressure, only 35 percent are aware of it--and you can bet a lot of those oblivious sufferers are men!

Maybe this difficult subset of patients can be reformed. Maybe, with the right education, the denial and embarrassment can be overcome and men can be turned into sensitive, caring, healthy specimens.

Maybe we men have to overcome the disease we all suffer from: our masculinity.

DR. PATRICK NEUSTATTER can be reached at
Email: pneustatter@prattmed.com.