An Unbridged Gap: Men and Health Care

Men and medical care may not mix, but you'll be surprised to find out why. According to a recent study, it may be more than machismo that keeps them away from the Doc.

By David R. Dudley

There's a scene in the comic movie Monty Python and the Holy Grail where the legendary King Arthur does battle with a mysterious knight who guards a bridge and challenges all comers. To Arthur's surprise, cutting off first one and then the other of the knight's arms doesn't dampen the warrior's fighting spirit. Hopping and kicking, the knight gives no quarter. The incredulous Arthur cuts off the knight's legs, then departs in exasperation as his immobilized but undaunted foe shouts curses and threats, proclaiming his invincibility to the last.

This gory battle scene may be a bit over the top, but judging by a recent report on American men and health care, the medieval machismo satirized by Monty Python is alive and kicking. In 1998, the philanthropic Commonwealth Fund commissioned a survey of 2850 women and 1500 men about their experience with health care. The original focus was on the women, but the findings on men were so alarming that in March the Commonwealth Fund published the data on men in "Out of Touch: American Men and the Health Care System."

David Sandman, Program Officer for the Fund's Health Care Coverage and Quality Program, says that "men often don't go [to see health care providers], and when they do go they don't talk."

Obstacles to care

Men's own attitudes are a big part of the problem. From an early age, many boys are taught to ignore pain and soldier on. The lesson often sinks in all too well, says Sandman, and the boys grow up denying their own bodies' physical limitations and needs. Like Monty Python's dismembered knight, they think they are–or should be–invincible.

Although delayed treatments often translate into worse outcomes, 24 percent of the men surveyed said that if they were in pain or felt sick, they would put off seeing a doctor as long as possible, and 17 percent said they would wait at least a week. Only a fifth of the men said they would seek medical attention as soon as possible.

A misguided tendency to "tough it out," however, only partially accounts for men's estrangement from the medical system. A second problem is economics. Men with lower incomes or without insurance are less likely to obtain adequate medical care. For instance, among adults earning less than $16,000 per year, a disturbing 35 percent of women were uninsured, but fully 50 percent of men were uninsured. "That's a clear result of public policy," says Sandman. He says that, as child bearers, women at the lowest income level are twice as likely to get help from Medicaid than are men.

The third major reason Sandman sees for the disparity between men's and women's connection to the medical system is that "men lack [the] natural gateway into the system" that women have. Women tend to get annual pap smears, if nothing else, and are likely thereby to establish a relationship with an obstetrician-gynecologist who may serve as a primary care giver. But there is no equivalent regularly scheduled encounter between men and doctors that can catalyze an ongoing relationship. One-third of the men surveyed did not have a regular physician to turn to when they needed medical attention or advice.

Assessing the gap

Taking all of these obstacles together, the upshot is that American men often fail to get either curative or preventive care. Some 24 percent of men surveyed had not seen a doctor in the year leading up to the survey, as compared with 8 percent of the women, and over half of the men had not had a physical exam or a blood cholesterol test in the past year. While the gap between women and men narrowed considerably by the age of 65 (when health coverage becomes more widely and evenly available through Medicare and health problems often become harder to ignore), screening for prostate and colon cancer in men over 50 was still unacceptably low, says Sandman.

Hispanic men were the most likely to be uninsured and to have inadequate access to health care, according to the survey, and African American men were more likely than white men to experience chronic physical health problems and depression.

Silver linings

On the positive side, says Sandman, those men who do see doctors "generally do like and trust their physicians," and many would like to have longer visits with them. But here, it is the doctors who often drop the ball. The survey suggests that doctors frequently fail to ask men about their family medical histories, or to give adequate counseling to men about issues such as smoking, drug and alcohol use, exercise, diet and weight, and especially about sexual health and emotional well-being.

Men who live with women fair better than their solitary peers, partly because women often manage family health matters and push their husbands, fathers and so forth into the doctor's office, and partly because multiple employers increase the odds of a whole family's being medically insured.

Meeting half way

Back in England, problems getting King Arthur's male descendents into the doctor's office have provoked health workers in the Midlands to set up clinics in pubs, where many men congregate and feel at ease. Along similar lines (but perhaps without quite so much drinking and smoking), Sandman says that maybe we should consider setting up health care where American men are more comfortable. He says many men seem to be more willing to get a quick check up in the cafeteria at work than to gear up for a trip to the doctor's office.

But men do need to meet doctors half way. "Men should take greater responsibility for their own health care," says Sandman; and "doctors need to be more attuned to the health care needs of men," initiating communication about sensitive but important health issues with their reticent male patients.

Sandman would also like to see more "public education campaigns that speak directly to men about the importance of health care even when they're feeling well." He cites the "milk mustache" ad campaign as an example of the kind of messages that have raised women's consciousness about osteoporosis and other preventable ailments.

Finally, "expanding health insurance coverage for low income men was a clear priority" that emerged from the survey, says Sandman. Along with the attitudes of men and doctors, the socio-economic environment in which they meet–or fail to meet–must change if the gap between men and the health care system is to be bridged.

You can read the Commonwealth Fund's report, "Out of Touch: American Men and the Health Care System."

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