Why Men Wait to Long – Written By Ray Wyman Jr.

For a complex set of reasons, men avoid doctors and damage their health.

Orange County Metro

Brace yourself men. The news from the gender gap is harsh. While the average lifespan of Americans is expected to increase to about 77 years, men will not be coming along for the full ride. By 2010, the average woman will live to the ripe old age of 81, while men will be kicking off, on average, at 74, according to the National Center for Health Statistics, a subsidiary agency of the Centers for Disease Control.

One key reason for the disparity is that men wait too long to seek diagnosis and treatment for both illness and injury. Men are taught to think of themselves as invulnerable. Asking for help may be perceived as a sign of weakness. John, Joe and Charley don’t need to go to the doctor. They can tough it out.

Men don’t want to admit that they are getting older. They want to stay young, and if the doctor is going to tell them they are, in fact, aging and need to slow down and deal with some “old guy” issues then they just won’t go to the doctor.

Men are afraid of painful procedures and unpleasant diagnosis.

They may feel that they are too busy to go the doctor or are caught up in high-pressure careers or that the doctor is too expensive.

Even the insured face high out-of-pocket medical expenses and – in a continuing echo of the Great Depression and the lean farmer years of the 19th century – thriftiness is still regarded as an important male virtue. A man knows the value of money and can do without, even if it means dying early.

Advantage, women
It seems that women have always lived longer than men. Since the dawn of modern medicine, scientists and physicians have been aware of the mortality gender gap. Many thought women lived longer because their roles as housewives and mothers were less stressful than traditional male roles. But when female longevity continued to outpace male longevity even as more and more women joined the workforce, researchers turned their attention to diet, hormones, high pain threshold, child birthing, genes and even the uterus for answers.

There is good reason to be concerned, and it’s more than for the sake of mere male pride. Other agencies like the American Heart Association, the American Cancer Society and the U.S. Census also are tracking this disturbing trend in mortality among men. More men than women die from the top 10 causes of death in the U.S.: heart disease, cancer, strokes, pulmonary diseases, accidents, influenza, diabetes, suicide, kidney disease and chronic liver diseases. Men are 1.4 times more likely to die of cancer and, on average, they suffer heart attacks 10 years earlier than do women. They die of diseases of the heart and liver at more than twice the rate of women, and they are 3 times as likely to be alcoholics, 5 times more likely to commit suicide and 9 times more likely to die of an injury.

Drs. Sheldon Greenfield and Sherrie Kaplan have spent most of their professional careers studying the quality of healthcare in the United States. The husband and wife team recently moved to the University of California, Irvine to co-chair the Center for Healthcare Research, where they are continuing 20 years of research into disparities in healthcare among cultures, social-economics and gender.

“While there are many measurable disparities between the classes, the disparity between men and women is especially startling,” says Kaplan, who is a social psychologist. “My hunch is that the situation is due to a survivorship advantage that we’ve given women from the very beginning. Men learn all the wrong lessons about their health, they don’t learn how to take care of themselves and they actually pick up behavior that is in conflict with good health.”

Greenfield, who is an internist, illustrates Kaplan’s point with an anecdote. He recently attended a healthcare symposium where he met a female journalist who was writing for AARP. During a lull in the meeting, the journalist disclosed to Greenfield that her husband hasdiabetes. “She started to complain: Not only will he not allow her to come to his doctor meetings, he won’t talk to her about what the doctor said and he won’t tell her his blood sugar level,” recounts Greenfield. “And this is one of the most sophisticated families you could find; they’re both highly educated, and this reporter has her hands on the latest information about healthcare. I said, ‘I can’t believe that your husband is like that’ and she said, ‘Well, that’s the way men are.'”

“The way men are” is captured in a plethora of recent health surveys. According to one conducted by pollster Lou Harris & Associates, men avoid routine checkups, preventive care and health counseling for a variety of reasons, including embarrassment, fear and lack of knowledge. Men generally ignore symptoms or delay seeking medical attention when sick or in pain. Overall, men pay their doctors 150 million fewer visits each year than women do. When men visit the doctor’s office, often it is because they are forced to by injuries suffered on the job, at home or at play. And when men do get treatment, they are prone to canceling follow-up appointments and less likely to finish their prescriptions.

Boys will be boys
One reason for men’s doctor resistance has to do with the psychological effects of aging. Many men will go years past their prime still clinging to the same sense of agelessness and invulnerability that nearly got them killed when they were younger. These men seem to have convinced themselves that they can stop the aging process entirely by the brute force of their denial.

American journalist and humorist Kin Hubbard once remarked, “Boys will be boys, and so will a lot of middle-aged men.” The joke resonates because it is true. Indeed, the behavior is so common that most people know middle-aged men who act as though they are still in their twenties.

“Women are acutely aware of their age,” remarks Dr. James Lundberg, who owns a medical practice in Irvine. “But when men age, they’re just developing character. When men look in the mirror they see the same guy

they’ve always seen and ignore the wrinkles and gray hair.”

The experts say that this state of mind may cause some middle-aged and older men to undertake unnecessarily risky behaviors. Aside from taking up extreme sports that are obviously dangerous, many aging men push themselves back into familiar activities like basketball or soccer where the danger to their health arguably is greater.

Tom Bokarre was an up-and-coming marketer in his prime, recently recruited by a national hardware wholesaler in Anaheim and doing quite well. He died in 1988 of a heart attack at age 37 while playing full-court basketball on the company blacktop. Wolf Bree was a well-known and successful entrepreneur. He died in 1997 at age 48 while playing soccer with young men from one of his factories. Bree had played soccer when he was younger but had gradually given it up as his business career blossomed. After a 20 years absence he made the fatal decision to dust off the cleats. Both were bright, intelligent men but they may not have seen a doctor in years.

These are personal anecdotes about friends who stuck their chins out just a little too far, but Kaplan agrees that the behavior is probably more common than we realize and could be worthy of study.

“It could be teleological,” she speculates. “We may have come from the primordial ooze that way – part of what made men ideal hunters and gatherers. They had to chase down beasts and throw spears despite the danger and in spite of injury otherwise their tribe might starve.”

Dr. Dennis Poole, a well-known chiropractor and fitness trainer in Orange, says that he frequently treats what he calls “men being boys” injuries. “Denial is a double-edged sword because we deny ourselves of the opportunities to keep fit and deny that we’re getting older,” he says. “A crash fitness program will likely produce injury or worse. Nature intended us to take things gradually; nothing is done quickly. You’re not going to run a mile the right way if you’ve been away from it for 20 years. Remember what Arnold said, ‘Take baby steps.'”

Our bodies our what?
Women are extending their lives because they have capitalized on advancements in modern medicine, Lundberg speculates. “In my experience, and in general, women have a much greater awareness of their health. Intrinsically, it seems they are interested in lifestyles that convey wellness.”

The reason for that difference, says Kaplan, may be that females are “captives” of the reproductive cycle. “Women are talking about breast cancer when menstruation begins at age 12,” she says. “They spend a lifetime of being aware of their bodies because that’s nature. The experience also teaches them the efficacy of regular interaction with doctors, because the consequences can be pretty severe if they don’t.”

Even as children, boys are less likely than girls to seek medical care. Says Kaplan, who did her dissertation on children’s use of the school health nurse, “At age 5, little girls were going to the school nurse for tummy aches and headaches while little boys were holding off seeing the nurse unless they suffered ‘crash and burn’ injuries on the playground.”

“This isn’t anecdotal,” adds Greenfield. “A substantial body of data shows that at a very early age males are using the healthcare system differently and for different reasons.”

Kaplan asserts what is probably going on is that we learn behavior modes from our parents that sensitize little girls to what is going on in their bodies while teaching little boys to just “walk it off.”

“But you can’t ‘walk off’ prostate cancer,” she says.

The big “M”
Kaplan and Greenfield say that the media bears a large responsibility for preserving and extending the gender miscues about body awareness and healthcare that boys learn at an early age, incessantly pushing icons of cultural maleness and anti-health messages to the forefront of American social consciousness.

“Women complained about sexist marketing and media. They organized and managed to bring about some significant changes,” says Kaplan. But men have been silent, either because they like the stereotypes or are unwilling to challenge them. Either way, from deodorant commercials to extreme sports advertisements, advertisers continue to hype the image of men as strong and invulnerable.

From childhood, males are encouraged to be tougher, stronger, and to eat bigger portions of food. According to research conducted by New York University and published by the American Dietetic Association last year, the trend toward “super sizing” started with 7-Eleven’s 1976 debut of the “Big Gulp.” The television and print ads were nearly exclusive in their images of thirsty men sucking down all 32 ounces in one sitting. It doesn’t take an expert to realize that a 32-ounce hit of ice cold sugar water isn’t conducive to good health, but men bought the image of themselves as larger than life characters with gargantuan thirst.

Ground-breaking books like “Fast-Food Nation” by Eric Schlosser and the upcoming, already controversial film, “Supersize Me” have alerted us of the high health costs of the supersize drive-thru diet plan, but Kaplan asserts that marketers continue to push men into a blind corner about their own health and care. “[Men] are being taught this behavior in the media,” she says.

Her conclusion is backed up by what is known in academic circles as a literature review, a process that involves painstaking census and plotting of keywords and phrases that are found in headlines of ads and articles in magazines and other publications.

With years of such work behind them, Kaplan and Greenfield have uncovered what they feel is strong evidence of media’s socialization of men’s current attitudes toward healthcare. Going over just a handful of their collection of magazine covers, it’s easy to see that there is a huge difference in terms of topic and substance. Good Housekeeping and Men’s Health are about equal in their tabloid-like display of articles about sexual performance and satisfying one craving or another, but the women’s magazines are conspicuous with healthcare tips and suggestions. A recent cover of Good Housekeeping brandished this teaser: “The Medical Test You Need Now.” In the men’s magazines, where we find what Kaplan calls “sex and knuckles journalism,” nearly all of the health topics are limited to “facts” about turning fat into muscle, 100 ways to look great and other “manly”topics. Splashed on the cover of a recent issue of Men’s Health was the headline, “Feel Better Instantly and Doctor-Proof Your Life!”

“It could be argued that marketing is playing to the audience’s interests,” says Kaplan. “But it could also be argued that they are shaping the audience’s attitudes and interests.”

White coat syndrome
Plain old fear is another reason men avoid going to their doctors. Many people are intimidated by the clinical atmosphere of the doctor’s office and by what they perceive as the doctor’s vast and mysterious knowledge. This phobia is so prevalent that behaviorists have a name for it: “White Coat Syndrome.”

Kaplan explains that the doctor-patient relationship still carries a primal feel. “The doctor is a healer, and we still regard them very highly in this culture and we are intimidated for that reason,” she says. “Especially when we’re standing there wearing a paper jonnie. Everybody is nervous when they’re naked.”

Adding to this fear, notes Greenfield, men are often poor communicators. Most have difficulty communicating to their spouses much less to a physician explaining medical treatments during a 15-minute office visit. “Some doctors try to be helpful by giving lots of information. Sometimes it may sound a

little like a lecture,” he says. “For 90% of patients, if they don’t understand something they’re probably not going to interrupt and say, ‘wait a minute, I don’t understand what you mean.’ Instead, most people become defensive, even irritable.”

Doctors may also represent a loss of control and status to males, of surrendering responsibility to somebody else, comments Lundberg. “I think that sense of loss might be one of the reasons why men don’t seek healthcare as often as they should,” he says.

The cumulative “white coat factor” shows up in 2 ways – either men don’t participate in healthcare or, when they do, they clam up. In clinical tests conducted by Kaplan and Greenfield, women asked about 6 questions during a 15-minute office visit, and, on average, the number of questions men asked was zero.

But all hope is not lost. For example, Greenfield points to changes in attitude toward prostate cancer . “It was groundbreaking what men like Joe Torre, Rudi Giuliani and Lou Asner did for prostate cancer awareness. They broke the ice, they put prostate cancer prevention into the news. Finally, it was OK to talk about it in public.”

Thanks to heightened awareness of the need for screening, prostate cancer mortality has declined, with 30,000 men dying of the disease in 2002, down from 41,000 in 1997, according to the American Cancer Society.

By comparison, about 39,000 women died of breast cancer in 2002, down from 44,000 in 1997.

So maybe you can teach an old dog new tricks, after all. OCM

Ray Wyman Jr. is a freelance journalist and author. Reach him at rwyman@heavypen.com. Letters to the editor go to: Feedback@ocmetro.com.
Five Reasons Men Avoid Doctors

1 The colon factor: Fear of painful procedures and unpleasant diagnosis keeps men out of the waiting room.

2 The time of their lives: Busy executives and professionals may rationalize that they don’t have time to take care of themselves.

3 Those damn genes: It may be that men ignore pain and illness because they are wired differently than woman.

4 Media stereotypes: From magazines to TV to movies, images of male toughness and invincibility are pounded into men’s brains, creating an unrealistic standard of strength and self-sufficiency.

5 Male ego: Men are embarrassed to ask for help, fearing a loss of self-image and status. Rather than admit to themselves or others that they are getting older and have physical weaknesses, they try to do what they were told in gym class when they were kids and “walk it off.”
The Future of Wellness

Modern medical science can accomplish wonderful cures. But the best path to good health is by way of being proactive about prevention and wellness. The problem is that America has a healthcare system that is tuned for treating symptoms, not keeping people from getting sick in the first place.

A company called flexSCAN, Inc. in Mission Viejo is trying to flip the economics of healthcare on its head by offering “patient directed” diagnostic and wellness services as an affordable employee health benefit program.

The core of the program involves painless diagnostic body scans to catch illnesses and injuries at an early, more treatable stage, instead of waiting for dire symptoms to force diagnosis and treatment.

The health assessment also includes an EKG, lab tests for cholesterol, blood pressure check and measurement of other vitals. Flexscan even photographs skin anomalies for follow up. Everything is digitized and placed into a personal electronic medical file on a secure website.

Information from the exam interacts with nutrition and fitness databases so that the enrollee can generate daily diet plans and a progressive exercise program.

“When our doctors find anything abnormal, they advise the patient to show the scan to their primary care physician for consultation,” says Banks, adding that the patient is the only person who has access to their personal medical file.

“To my knowledge, we’re the only provider for this type of service,” says Thomas Banks, president and CEO. “It is the future of healthcare; it turns control over to the employee and empowers them to take better care of themselves. We may even end up helping to reduce the overall cost of healthcare by catching problems very early.”

Trademarked under the name “mywellness360,” the firm’s novel approach for “wellness management” has attracted the attention of human resource managers from dozens of businesses and organizations in Southern California. According to Banks, among the early signers are the San Diego Municipal Employees Association, the San Diego Teachers Fringe Benefits Consortium and Guess? Jeans.

One Source Distributors, Inc. in Oceanside signed up for the program last August. According to HR manager Jan Pruett, the program has worked very well, and about 40 employees from her company have enrolled. “One of our employees had the scan last year and caught something early, so we’re all pretty excited. We have enough people and they’re bringing the equipment to our site to do all the tests,” she says.

According to Banks, participants in the program are eager to take full advantage of its services. For example, he claims that more than 75% of men who are currently enrolled elect the virtual colonoscopy CT scan. “They like this service over the alternative because it is an entirely non-invasive procedure that produces a high resolution virtual model of any organ,” he says.

Pruett describes what attracted her company to the program was its “win-win” proposition for the employee and employer. “The membership fee is charged on pre-tax income to the employee, and there’s no cost to the employer,” she says. “Employees get about a 40% reduction in cost for the services, but it’s more like a 60% reduction when you include the tax benefit.”

Banks says the firm is on track for 250,000 enrollees by the end of next year.

-By Ray Wyman Jr.

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