Dodging the doctor - are you man or mouse?

Geri_Berri · **Geri_Berri**

Dr Hilary Jones explores the wimp factor that leads even macho men to avoid seeking medical advice

Why are men so bad at going to the doctor? Men are four times less likely to consult a doctor when they experience medical problems, even though a man's average life expectancy is six years less than a woman's, and men are much more likely to be admitted to hospital as an emergency with something serious or life threatening! Women have been teasing us men for years that if we had to have babies, none would ever have been born. What is behind men's carefree attitude to their own health?

Self-neglect
The facts about men's health do not make encouraging reading.

45% of men are overweight.

One third of overweight men are clinically obese.

60% are physically inactive.

Twice as many men than women drink above the maximum recommended alcohol intake.

7 out of every 8 men have at least one risk factor for heart disease and stroke.

Only 25% of men with high blood pressure have their condition controlled by medication.

Despite the fact that testicular cancer is the commonest cancer in men between the ages of 20 and 40 years, a whopping 87% of European men never examine their testicles.

In the case of testicular cancer, I'm pretty sure men know where to find their testicles - it is just that many men assume that their 'family jewels' will function normally, enjoy regular employment and never go wrong. Similarly, prostate cancer is just as common as female breast cancer, but how often do we hear men talking about the importance of screening or the detection of early signs of abnormalities like women do? How many have even heard of the prostate gland and know where it is and what it does? The tragedy is that many cancers are curable if caught at an early stage of the disease - this is especially true of testicular cancer. Similarly, statistics show that skin cancer occurs in equal numbers of men and women, and yet men are four times more likely to die from it. The difference is almost entirely attributable to the fact that women seek medical help sooner than men.

Embarrassment and the 'white-coat syndrome'

Part of the problem is men's embarrassment about their own bodies, coupled with an aversion to doctors ('white-coat syndrome'). Many men struggle to find the appropriate words to describe anatomy and function, particularly for intimate areas of the body. Many feel that they might be judged or mocked for their condition. 'Promise you won't laugh' is a phrase I've often heard in the consulting room, although paradoxically these same male patients often find their condition vaguely humorous. Perhaps they find it easier to keep quiet about rectal bleeding, to assume that really they just have piles and not bowel cancer. Women do not seem to have such hang-ups. They may still feel self-conscious but not to the extent that they will stay away from the surgery. Men, classically, will dodge the doctor if they suspect that they will have to undergo an intimate examination too. Part of this is cultural. As the doctor's old joke goes, an American man undergoing a thorough health check will sue if his doctor does not perform a digital rectal examination (DRE), with his gloved finger, whereas a British patient subjected to a DRE is likely to sue for GBH! The lesson behind the joke is that the American patient knows the DRE can detect prostate enlargement and bowel disorders; whereas the Brit knows only that it is humiliating.

Male machismo has much to answer for. Men and boys are programmed to be tough, brave and independent. We are supposed to take pain in our stride. But while some men can boast wounds inflicted in the heat of battle, the torn cartilage sustained on the football pitch, the blackened eye and bloodied lip incurred in street fights, we dare not mention frequent urination at night or impotence. Few men are likely to earn pats on the back from their male peer group for mentioning symptoms related to stress, anxiety, depression, chest pain, baldness, smoking or alcohol consumption. Some men still think that a man is 'hard' if he takes unnecessary risks in life and smokes and drinks to excess. Arguably, all our role models are still just modern versions of swaggering John Wayne, the gun-slinging, bar-brawling, hard-drinking, womanising, all-conquering hero. Modern men's lifestyles also leave a lot to be desired. Real men, as the saying goes, do not eat quiche, nor, for that matter low fat or low calorie options or anything else that is good for their health. The message of healthy eating has been pounded into the population so many times that there can be few people left who do not know what a healthy diet is; the problem, it would seem, is making people follow a healthy diet. For some men, traditional macho attitudes are incompatible with eating spinach ravioli parcels.

Excuses and denial

It is always possible to make excuses for oneself when denying that anything is wrong with one's health. Men are past masters at this and doctors have heard them all: let me recite a few:

'It's difficult to get time off work to see the doctor.'

Really? When do you play golf?

'I'm suspicious of the side effects of prescribed drugs.'

Drug scare stories are legion but in reality most are subjected to years, sometimes decades, of testing before being brought to market. Bottom line: prescription drugs are safe if prescribed and used properly.

'I'm the family's breadwinner and I cannot afford to face bad news.'

Why then should you make matters worse by postponing the visit?

'I can't see the doctor because the doctor is a woman and I've got a waterworks problem.'

Understandable, but you can always ask to see a male colleague at the practice. If that is not possible, remember that you can change your doctor as many times as you like. You are not compelled to say why you want to change. Moreover, your privacy is assured by our professional code of conduct - a doctor will find themselves in deep trouble for breaking doctor/patient confidentiality.

Q: Why can't a woman be more like a man?
A: ....because that would take an average of six years off her life.

Men need to start communicating their health problems to one another like women do. If only men down the pub could share work responsibilities, domestic concerns and relationship difficulties as easily as football scores and dirty jokes; they would all avoid a great deal of accumulated stress and psychological tensions. But instead of emulating women and their better approach to good health, some men have never graduated from a childhood in which all their health problems were dealt with by their mother. In our childhood, women adopted the role of carers in the family and in society as a whole. They fed us, nursed us and washed us. They took us to the doctors and had us examined and vaccinated.

Some women still make our medical appointments as adults today, and drag us kicking and screaming to the clinic because there is no other way we will get there. Men must accept that the responsibility for their health lies not with women but with themselves and no-one else. Next time you find yourself dithering about a health appointment remember this: if you cannot make time to be healthy, one day you will have to make time to be ill.

Source - http://www.netdoctor.co.uk/menshealth/feature/manormouse.htm