Why don’t men go to the doctor?
Nine years had passed since I’d had health insurance, though it was at least fifteen since my last routine checkup. I didn’t even know how to find my medical records. Because I just turned forty and got insured through the Affordable Care Act, I decided to finally establish primary care and do blood pressure, cholesterol, and cancer screenings. “While you’re there,” my girlfriend Rebekah advised, “have them check your toe.” I had a bum toe. It hurt but I’d worked around it for two years. What I called ‘busted’ was probably arthritis, not that I ever said the word ‘arthritis’ out loud.
According to the American Academy of Family Physicians, 85% of U.S. men seek treatment when they’re sick, and six out of ten of them go to a doctor. But most doctors will tell you that American men, far more than women, avoid the doctor and routine physicals with a devious cunning. It isn’t because we’re tough or less susceptible to illness. It’s because we’re idiots. Instead of embracing the power of knowledge and early detection, men stubbornly resist information and treatment for the short-term gain of autonomy and convenience, as if by avoiding the details of our lives, they won’t affect us. If ignorance is bliss, then making things easy is awesome. That’s unconscious dude logic. Why get that rash checked when all our other rashes went away themselves? Just hobble around on that bad toe and hope for the best — or don’t hope; just get used to the new painful paradigm and proceed as usual. Who has time for this stuff? So you’re short of breath and have occasional chest pain. You and everyone else, man. Suck it up. Life’s busy and work is stressful. You haven’t died yet. The thing is, you might die if something serious goes undetected, and that pain won’t always pass. Ignorance is not bliss, because knowledge is power. Men can be such dumbasses. My dumbass had postponed a simple checkup for my entire thirties.
Why don’t men go to the doctor? “I just don’t do it,” my coworker Dan said with a shrug. He’s forty-nine and hasn’t seen a doctor in probably twenty years. “I’m fine.” Two local primary care doctors I know admitted they haven’t had a check up in nine and fifteen years, respectively, for the same reason.
During my first doctor’s visit in over a decade, a nurse sat me in a small room and asked a series of questions: Any specific issues? Are you a smoker? How often do you drink? Do you have allergies or take medications? My answers to her other questions were no, no, a little, no, no. “Well,” she said, “aren’t you just an easy patient.” With no kids, exemptions, or government subsidies, I told her, my taxes were just as easy.
The nurse read my blood pressure at 110 over 72. Apparently, that was good. I didn’t know, but I wasn’t surprised. I don’t smoke. I don’t do drugs. I drink alcohol sparingly and drink tons of green tea. In the words of a woman in line at a Japanese market where I was buying stacks of canned fish, I eat “like a Japanese person.” That’s my preventative regimen: fish, seaweed, miso, tofu, tea, little refined sugar and very little dairy. Despite our best efforts, though, the body breaks down, and family history plays a role in our health. My dad’s side of the family is plagued with ham-, biscuits-and-gravy- and enchilada-induced heart disease, cholesterol and diabetes, which is one reason I improved my diet in college in the first place.
The nurse left and I waited for my new doctor. The room was small. It had bare cement floors, an exam table, and two wooden chairs by a long counter crowned with a bottle of Purell. Three boxes of rubber gloves hung from the wall by my chair. Three seemed excessive. It was hard not to interpret them as a warning about the rectal exam I was sure loomed in my future.
My new PCP came in and introduced herself as Suki. She reviewed my answers to the nurse’s questions, asked about my family history, and laid me on the table to do some exams. My blood pressure was good, she said, my BMI, glands, ears, eyes, all good. The next step was blood work. “Blood test will tell what’s happening inside you,” Suki said, “especially with your family history.” I scheduled the blood draw for 8 a.m. the following week. The line to make an appointment at the front desk took longer than my exam. The whole visit was so quick and easy that it seemed ridiculous to have avoided it for so long.
A 2007 American Academy of Family Physicians survey said 23% of men avoid the doctor because “they are healthy and don’t need to see a doctor.” 36% “only go to the doctor when they are extremely sick.” 8% don’t like the doctor, and 7% avoided because “they are afraid of finding out something is wrong with them.” It isn’t just checkups. Men with symptoms and on-going problems still won’t come in.
“It’s a pretty well understood fact,” said one PCP I’ll call Brian. “Most of my male patients who do come in, their ears are a little red from all the twisting their significant other did to get them to see the doctor.” When Brian was an intern, he saw one patient who came to the hospital after enduring sixteen hours of crushing chest pain, nausea and vomiting. “He decided to come in the very next day,” Brian said, “to, quote, ‘find out what that was.’ ‘Well sir, you had a heart attack, and it would’ve been nice if you came in yesterday instead of today.’ But denial is not just a river in Egypt, right?”
Adults aren’t the only culprits. Boys can be very stoic and disguise their pain so well that doctors miss a diagnosis. Brian recently did a vasectomy on a twelve-year-old. Around that age, boys’ testicles twist, and they can twist on the testicular artery in a way that it cuts blood flow to the testicle, which causes a lot of pain. When the patient came back later, he told Brian, “Yeah it swelled up really bad, and it kind of hurt a little bit, and then I felt better in two days, and then the testicle just shriveled up and went away.” That’s because the testicle was necrotic. It died, and the boy hadn’t sought medical attention. “Sometimes people just tough it out and walk it off,” Brian said. “I don’t understand it fully.”
According to him, the causes are multifarious. “Some of it’s probably cultural,” Brian said. “We’re told to be self-reliant and not to worry about it. Some of it’s just the male psyche, that same psyche that makes us feel comfortable putting a gun in our hands and going off to war, a sense of invincibility.” As the old saying goes: doctors often make the worst patients.
Brian is forty-three, has worked in medicine for almost two decades, and his last physical was his pre-residency physical in 1999. He hasn’t seen a doctor since he was forced into the ER when he crashed his bike and blacked out in 2000; after flying over his handlebars, he woke up while the paramedics were strapping him to a backboard. Why the avoidance? “I get my annual flu shot at work,” he said laughing, “a tetanus shot regularly. I go to the dentist.” He has a little dermatitis, which he treats with hydrocortisone. He has some allergies, but he can use over-the-counter medications for those. “I’m fine,” he said. “Fine enough.” He also knows that an annual checkup isn’t going to save him.
Traditionally, patients were told to get examined once a year, but the medical community’s belief in the efficacy of the annual checkup is changing. “The idea that having a physical at age 20 or 30 is going to make you live longer than if you don’t do that until you’re 50, is probably not true,” Brian said. “It depends on your age, your risk factors and your medical condition.” For men between ages eighteen and thirty, many primary care physicians believes it’s reasonable to get examined every three to five years. Unless you’re overweight, have diabetes, a family history or other risk factors that need to be addressed, it isn’t suicidal for a man to wait until they’re 40 to get an exam and check their cholesterol, as long they get immunized regularly, get a flu shot, and get their blood pressure checked annually. You can do that at a grocery store or pharmacy. “I certainly wouldn’t recommend you only go to the doctor every 10 years,” Brian said, “you need to establish care so you have a doctor to go to when you are sick. But the idea that you need to come in every single year to stay healthy is not helpful.”
As for the ER visit in 2000, he said, “I haven’t gone to the doctor since.”
One reason women are more comfortable seeing a doctor, and going in for regular checkups, is reproductive health. Issues such as birth control and abnormal periods bring women to the doctor more regularly and at an early age. Women get in the habit. They get used to making appointments and keeping up on their body’s condition. Unless something burns when we pee, or we have a chronic health condition from a young age — or they’re hypochondriacs — fewer men reflexively reach out to doctors for help.
Another reason is cultural: women seem more used to asking for help. They’re comfortable with it, less threatened by the implicit vulnerability of assistance. Men can be stubborn, know-it-alls, and mansplainers. Asking for help isn’t a distressed damsel situation. It’s a sign of strength. Sometimes the best way to solve a problem is to ask a professional for assistance. Men show how weak and foolish we can be when we mistake extreme self-reliance as strength; true strength comes from asking for help when you need it, and when you’re hobbling around on a bad toe, or you have chest pain, you need it.
Aside from general male stubbornness, many of us don’t want anyone infringing on our autonomy. We want to drink, play sports, and eat what we want whenever we want, as if we were eighteen. So we avoid the doctor to avoid being told what we don’t want to hear. When our girlfriends or wives ask about our health, we often lie. We withhold information. We do the same with doctors. When a doctor asks, “Any specific issues to address?” too many men say, “No, I feel great,” even when we don’t. I did this myself.
When Suki asked if the pelvic exam felt okay, I said yes. Then when she told me to sit up, I admitted there had been a little tension down in my lower right part of my abdomen, below my beltline. She felt it again. “How long has this been going on?”
I said, “Just now.” That wasn’t true. I’d felt it the last three days. I didn’t want to deal with it then, and I didn’t want to deal with it now, yet I was still concerned enough to mention it in passing, however scaled down a version of the truth. Although I’m concerned about what this tension is and that it might get worse, my withholding of information proves that I’m more concerned about my time than my health. I already do stretches in the morning. I don’t want to add any more time-sucks or medications to my daily routine. Maybe my skinny jeans are too skinny. Maybe they’re pressing on something vital along my waistline. Suki advised I let her know if the tension continued. It has on and off since my exam, but not enough to talk to her more about it. This is a stupid approach to your health, yet I’m aware of it even as I’m doing it.
I’m worried about a lot of things. Even though I no longer abuse my body the way I did in my teens, my job keeps me seated at the computer too much. I don’t exercise enough. I might look lean and clean from the outside, but with my family history and my excessive sitting, the time has come to make regular exercise as central a part of my health regimen as diet. I would not have made that change had Suki not told me I needed to. When I asked her how much a forty-year-old should be exercising each week, she advised thirty minutes a day, every day. Then she said, “You need to do this. Jog, hike, bike — whatever, but it’s important.” She provided an unanticipated prescription on my visit: motivation.
I went in for a blood draw on Friday morning. Then I skateboarded to work to get exercise.
A nurse called the following Monday. “We got your blood work back,” she said. “Everything looks good and normal.”
“Really?” I said. “Good and normal?” That’s right. No diabetes, no cancer cells, healthy cholesterol levels. I wasn’t shocked, but I was relieved.
The nurse said, “Okay, you have a nice day.”
“Thanks but just a second,” I said. “So that’s it?
She said, “That’s it.” Suki said that new patients could schedule a follow up appointment in three months if they wanted. Otherwise, unless I had an issue that required treatment, we were done.
I held the phone to my ear and thought, That’s what I had avoided for fifteen years? Everything’s good and normal? In one sense, this just confirmed my own hyper-individualistic male thinking, that I had been right to avoid the doctor all these years, that I didn’t need checkups at all. I was fine. The visit might have felt anticlimactic, but it was a valuable lesson in the changes that come with aging. I might not have needed to adjust my diet, but I needed to start exercising. And I have: I’m riding my bike, doing jumping jacks, and skating more, for at least thirty minutes a day, or an hour every other day. I also learned that I had ten more years to postpone other things. At the end of our visit, I asked Suki about prostate cancer and colon exams. “You won’t need a colonoscopy until you’re fifty,” she said. I grinned and felt my whole body go slack. See, I thought, that wasn’t so bad.
This article originally appeared on Medium for Human Parts.
Photo credit: Getty Images