NYT: What Does It Take to Get Men to See a Doctor?

The Cutler Center is one of the few clinical spaces trying to tackle the stubborn problem of men’s lack of engagement with America’s health care system.

Right now, men in the United States, whether infants or elders, are more likely to die at younger ages than their female counterparts. Male life expectancy at birth is currently 75.8 years — 5.3 years less than it is for women.

Our culture is pretty messed up when it’s noteworthy that the NYT and part of the medical community acknowledges that men and women are different.  It’s not so great that this issue is presented as a problem with men and our lack of engagement in the health care system, rather than a problem with the health care system failing men.  At least they are talking about topic and trying to find a solution.

Since this is the NYT, some space has to be given to the idea that maybe men should just be left to die 5 years earlier than women.

The idea of devoting any extra attention to men’s health can seem “counterintuitive,” Derek M. Griffith, a health-policy professor at the University of Pennsylvania and a leading expert on men’s health disparities, acknowledges. “Men are advantaged in so many areas of society. It’s natural to ask, ‘How much should we care that your health is still poor?’” After all, he adds, “we built our whole society with you in mind — so you had your shot there, dude, you won the lottery. And you want us to give you more? Come on.”

Men who are up on a utility pole in the rain trying to restore power or sitting in domestic court listening to a judge terminate their child custody rights, may not feel that the patriarchy really benefits them.  A NYT reader expects this trite man-hating bigotry in an article about men’s health.

As soon as I stepped off the elevator at the Cutler Center for Men earlier this summer, I was greeted by a smiling woman with short gray hair in an athletic half-zip top, standing in front of a sign that read, “Welcome Guys.” Past check-in, there were pool tables and foosball tables and two giant-screen televisions showing replays from the N.B.A. finals between the Thunder and the Pacers. A small cafe, decorated with vintage album covers and a classic arcade game, offered flavored water and coffee.

This “Hey bro, how’s your sport ball team doing?” approach isn’t going to work.  It’s a stereotype of what men want.  The place sounds fun and expensive, and since it’s at a University Hospital location outside of Cleveland, I might try to get an appointment there.  My doctor is with UH, so I’ll ask him about it.

I can’t help wondering who a guy is supposed to play foosball or shoot pool with.  If they insist on showing NBA replays, at least feature the Cavaliers at a greater Cleveland site.

Since the woman who wrote this article doesn’t know, I can tell her what men like. Call it the “Five P’s”.  Men like problem-solving, protecting, providing, prestige and peeing in the snow.  Men don’t like pedantic lectures or bullshit.  With regard to the health care system, men don’t know what to do.

That disparity has many causes, one of which is that men simply don’t go to the doctor as often. The problem begins early: After pediatric care, young men largely disappear from medical settings until after serious issues arise. Women tend to see their gynecologists regularly; men have no clear equivalent.

That’s a good observation.  Men like autonomy and objectives.  Going to the doctor for an annual physical doesn’t accomplish anything.  The man gets his weight and blood pressure taken, then talks to the doctor for a little while.  There might be blood work.  The doctor says some platitudes about diet and exercise, and we’re done.  Platitude equals pedantic lecture.  Nothing accomplished.

Everyone should have a primary care physician.  That doctor is the gateway to the system.  When a person gets a new job and a new health care plan, there should be a visit to a primary care physician.  Human Resources at the company can and should help with that.

The primary care physician needs to explain why annual visits are important.  Something like, “You are pretty healthy now, but we want to get baseline stats on blood pressure, cholesterol, blood sugar, and other parameters so if something starts changing, we can catch it.”

The doctor should provide a checklist of routine tests that will come up at specific ages, and explain the same baseline data approach.  On the patient’s phone, set up MyChart at the first appointment.  Also, configure MyChart to send out a text reminder for next year’s appointment.

Male doctors are not regular men.  They went to med school, and we didn’t.  Lectures and boiler-plate advise isn’t going to work.  At my initial physical exam with my current doctor, he told me that I should lose 20 lbs.   I called bullshit on him.  “No kidding doc.  You didn’t go to med school to tell me something obvious.  What else have you got?”

Different men will need different advise, but make it practical and actionable.  “I want you to get your heart rate above 130 bpm for a half-hour per day.  Here’s a Youtube video about WW II calisthenics.” might work with some guys.  Or recommend a gym.  Or coordinate work-out buddies.

The loneliness epidemic amongst older men is occasionally talked about.  Every retired single guy should be given a dog.  Older guys who are still working, should volunteer at an animal shelter.  That is a target rich environment.

Men want to be in charge of their own health, but to do that, men need solid information and specific advise.

If University Hospitals want to make the doctor’s office more inviting, dump the pool tables and foosball.  If they want to do something innovative, hire cute girls to work reception.  At a variety of doctor’s offices, the reception women seem to be part of a rehabilitation program for women with unnatural hair colors and excessive body art.  Hire high school or college girls.  The nice ones, who aren’t jaded or in an experimental phase.  Nobody is going to harass or hit on them, we just like nice people.

Yeah, I know, that all sounds crazy.  To men, the health care system sounds crazy.  They should work on that.