Why men don't visit the doctor ... and why they should
June 14, 1999
Web posted at: 2:50 PM EDT (1850 GMT)
By Daniel Hayes, M.D.
|PROSTATE-CANCER SCREENING: IT'S STILL CONTROVERSIAL|
|For all men over 50, and men over 40 who are at high risk (those who have a family history and/or are African-American), the American Cancer Society recommends annual prostate-specific antigen (PSA) testing and direct rectal examination. But other authorities, such as the United States Preventive Services Task Force, do not recommend screening because of unproven effectiveness. If you are over 50 you should consult your doctor when making this decision.|
He was walking toward me, eyes bright, taking it all in -- the light reflecting off the leaves, the river. Most men his age began their day collecting billable hours in the asphalt jungle. But this fellow, in his 50s, appeared to begin his mornings in the park. I had seen him many times and decided to ask him about his circumstances.
"You seem to be enjoying yourself," I said to him as he approached.
"Yes," he said. "And I do this faithfully. But I haven't always done so." He said that he'd been taking his morning walk since recuperating from a heart attack two years ago. "Herbal therapy!" he laughed and took in a big breath. "Smell that cedar?"
"My doctor told me I had to change my lifestyle or else I would die," my acquaintance explained. "Prior to that I had been in denial about my need for real change." Since he'd started walking, he'd experienced a significant drop in blood pressure. His excessive anger began to abate. He felt less urgent and stressed. "I began to leave the office at five and to say things like 'It can wait.' My wife asked me if I was okay. My partners had me in for a little chat -- my 'production' was down and they were 'concerned.' In fact, I had to let go of some friendships that kept dragging me back into the fray."
Had my new friend started going to the doctor regularly and making lifestyle changes early on, could he have avoided a heart attack? Probably. So why was this seemingly intelligent man suffering from poor health choices that he had made in the past, like millions of men? The reasons are many.
1) Men aren't socialized to routinely visit the doctor
John W. Saultz, M.D., professor and chairman of Family Medicine at Oregon Health Sciences University, points out that women experience continuity of care from childhood, while men are pretty much left to their own devices after they hit puberty. "Boys and girls get the same amount of health care -- well-child care, immunizations -- during infancy and early childhood," he explains. "Where things really diverge is at the time of reproductive maturity, at around age sixteen, when women see physicians for preventive gynecologic or maternity care and establish a lifelong pattern for seeing physicians. Men do not."
2) Men tend to rationalize reasons to avoid seeing the doctor, dealing with the emotional conflict by giving themselves reassuring but incorrect explanations in order to continue the behavior. Men may also handle the stress about fears of becoming seriously ill by exaggerating the negative qualities of the health-care system.
3) Men practice the art of denial. Like my new friend from the park, some men simply refuse to acknowledge the toll that a stressful lifestyle has on emotional and physical health until they're hit with a life-threatening condition. Even though the repercussions may be obvious to those around him, the man who is continuing to burn both ends of the candle may not be ready to admit to the decline of his health.
4) Men don't equate doctors with preventive health until they are in their 40s. "In your 40s, your parents tend to become seriously ill, which changes your view of your own health and health in general," explains Saultz. "Also, your own health problems become more significant -- higher blood pressure, chronic back pain -- and may require more frequent visits to the doctor. These things converge to make men think about health more in preventive terms and get them into their doctor for regular screening."
Regular doctor visits can save men's lives
Unfortunately, men avoid going to the doctor, even in the face of some pretty compelling evidence that getting in to see a doctor -- even when they don't have a specific problem -- is a good idea. Evan Kligman, M.D., and Frank A. Hale, Ph.D., authors of the "Health Maintenance for the Adult" chapter in the Manual of Family Practice, point out minimum preventive health recommendations that all men should take:
All adults should be regularly screened for risk factors for coronary artery disease, such as tobacco use, elevated cholesterol and triglycerides, a sedentary lifestyle, a family history of genetically inheritable diseases, and hypertension. We know, for example, that 50 million Americans are hypertensive, but only 35 percent are aware of it, according to a 1993 Archives of Internal Medicine article.
Screening for colorectal cancer is now recommended for all adults over age 40. For certain high-risk individuals, a regular colonoscopy will detect 95 percent of colon-cancer sites. Colon cancer is the leading cause of cancer death in the United States. Risk is increased threefold if you have a first-degree relative with cancer. Other risk factors include a history of ulcerative colitis, intestinal polyps or a family history of polyps.
Many millions of Americans are unaware that they have mild diabetes, a treatable condition that can be diagnosed with simple screening. When left untreated, diabetes can cause impaired vision and blindness, loss of kidney function, nerve damage, heart attack and infections.
Copyright 1999 by WebMD, Inc. All rights reserved.
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