Shandor Weiss, ND, LAc
What is the No. 1 issue in men’s healthcare? I propose it is this: getting men to take care of their health. This includes not only getting men to see a doctor, but also to follow through with their doctor’s recommendations. Regardless of what kind of health problem a man may have, a doctor’s knowledge and skill is useless to help him without that man becoming a patient. So, getting a man to see a doctor is essential to the professional practice of men’s healthcare.
It is well known that men do not see doctors as often as women do. Excluding male children and geriatric patients, men make up less than 25% of all office visits to doctors (CDC, 2000). This disproportionately low number of male visits to doctors is not explained by higher rates of some illnesses among women, or by women needing more care for gynecological conditions.
Once male patients do seek care, they are less likely than female patients to maintain continued care. It is not enough to know how to treat men’s health conditions; as doctors, we also need to be able to encourage compliance.
This article describes a few of the reasons for the disparity between male and female healthcare behaviors. It also offers some solutions for getting men to become patients and to be proactive with their health. Please keep in mind that these discussions are only generalizations.
Reasons Men Do Not See Doctors
Men don’t like to wait at doctors’ offices. A corollary to this is that men have more of a sense of importance and competition than women do. Being made to wait is a threat or challenge to their masculinity, sense of self-value and social hierarchy. Accordingly, men often feel that they should not have to wait, and that they should be compensated for time spent waiting. “My time is valuable, too!” is a common sentiment. There is a feeling of competition with the high rates the doctor charges, also. A carpenter, for example, who makes $20/hour, may feel threatened by losing a few hours’ worth of wages when seeing the doctor. Waiting for the doctor conveys the message that the male patient’s time and work is not important, while the doctor’s is. Men may feel challenged or dominated, with no way to compete.
Possible solutions:
- Make changes in scheduling and office procedures to minimize waiting time for male patients. Of course, this is important for all patients, but in order to “keep” male patients it may be necessary.
- Add lunchtime, evening or weekend hours for male patients.
- Acknowledge the value and importance of the patient’s time. The doctor can use phrases like, “Thank you for taking the time to see me today. I know you must be busy, and that your time is valuable.”
- Encourage male patients to come in for care on a drop-in or last-minute basis (as the doctor’s schedule permits), so the patient can take advantage of last-minute “down time” in his own schedule.
- Make appointments shorter for men.
- Encourage the use of telemedicine (phone calls, e-mail, fax, webcam, text messages, etc.) with male patients in lieu of some office visit time.
Health services are feminized. The idea here is that doctors’ offices, waiting rooms and treatment rooms (even bathrooms) are decorated with women in mind. Magazines are often of more interest for women. Even the act of reading a magazine while waiting is associated with women. The result is that men feel unwelcome and uncomfortable. In addition, this is a self-perpetuating issue: More women at the doctor’s office makes men feel that it is “unmanly” to see the doctor. To make matters worse, doctors are more accustomed to dealing with female patients. Both male and female doctors might relate to male patients in the same ways they relate to female patients.
Possible solutions:
- Add more reading or other media materials of interest to men. In the lobby or waiting area, consider a men’s section or area with different décor and reading materials, or a TV with political or sports content. Consider adding active entertainment like sports games, exercise equipment or a computer terminal.
- Try to schedule male patient appointments near each other, so they see other men in the waiting area and doctor’s office.
- Hold special men’s health clinics, talks or shifts.
- Find out what “male” interests each patient has, and be able to discuss or mention these during the visit (e.g., “How’s the golf game?” or “What about those 49ers last night?” or “How’s that engine rebuild you’re working on?”)
- Encourage women to bring their male spouses to their office visit.
- Make mental shifts between female and male patients. Use gender appropriate language, body language and other forms of communication.
Men are embarrassed to discuss emotional, sensitive or intimate issues with doctors. Men often have a more difficult time talking about issues related to a health problem, or even with talking about certain kinds of health problems. For example, a man with a prostate problem may resist seeing a doctor, simply because the problem is about a part of his anatomy that he is sensitive about. He may fear the inevitable exam, or discussions about sexual performance. Even when a man does make an appointment with a doctor regarding a prostate problem, he will often avoid the subject while talking to family, friends and the doctor’s office staff. The appointment will be made for an “acceptable” problem (e.g., back pain), and the doctor only finds out what the patient is concerned about once inside the office with the door closed.
We should remember that male patients can be just as sensitive as female patients; however they may show their sensitivity in different ways.
Possible solutions:
- The doctor’s staff should be trained to not “pry” too closely with male callers, and to be sensitive to a prospective male patient’s hesitancy to talk about the reason for the appointment. Policies should be flexible to accommodate the reluctant prospective male patient.
- The doctor and staff should recognize that men may be sensitive about issues that are taken for granted with female patients. For example, some male patients may not want to be recognized or have attention drawn to them when they enter the doctor’s office or front desk area.
- Male patients should be informed of privacy policies and protocols, so they are reassured. Privacy protocols should be followed carefully, especially where the male patient is “exposed” to other people, e.g., at the front desk or on a message being played on an answering machine.
On typical lists of reasons that men don’t see doctors as often as women do, the following five reasons are closely related, so the comments and solutions will address all five together:
- Men don’t see doctors unless it’s necessary … and perhaps, not even then
- Men are not socialized to see doctors (doctors are for boys, not men)
- Men are taught to ignore or suppress pain and illness (i.e., “suck it up”)
- Illness is a sign of weakness or dependency
- Men have a fear of being judged as having a weakness or being imperfect
As young boys become older boys and young men, they are culturally conditioned to ignore or suppress pain, not admit weakness, not seek help and not admit to being wrong or imperfect. Any man who was on a high school or college sports team or in the military knows about this. Even as boys and young teenagers, males are told by fathers, coaches, commanders and peers to “suck it up” – to go on despite feeling pain or feeling bad. While female teens continue the pediatric practice of seeing doctors, male teens tend to stop seeing doctors unless there is a catastrophic injury. They see their sisters, mothers and girlfriends going to doctors (but not their fathers or brothers), and they develop an assumption that doctors are for females, not males. They see that when men do go to doctors, they are usually old and frail, or about to die. This pattern is continued into adult life. Many men will not see a doctor until they have a life-threatening heart attack or incapacitating back pain. The severity of the health problem has to justify seeing a doctor. Going to a doctor simply to “feel better” or for non-catastrophic needs is simply not done.
Even when young men do see a doctor, the doctor is often a team or sports doctor. This doctor can perpetuate the conditioning by encouraging the man to be tough, and by possibly providing medical care that suppresses symptoms so the man can continue with his routine. If a sports medicine or military doctor enables or encourages a young man to play or work with injuries, this further conditions the man to ignore his body’s warning signs. When these men get older, they think they should go to work no matter how bad they feel, and that seeing a doctor is unnecessary because he would just tell them to keep doing what they were doing.
Similarly, men with worker’s compensation injuries and cases are often pressured to ignore or minimize health problems, and to return to work prematurely.
These attitudes about healthcare affect men of all ages. Even men who are retired, who no longer face work and productivity pressures, may maintain the conditioning from their earlier years. In fact, some older men are difficult to treat because they equate being ill, and the need for doctors and care, with loss of manhood. For these men, the fact that Medicare or insurance pays for care makes little difference. However, it is even less acceptable for these men to see NDs who are not covered by such plans.
When I was in naturopathic school, my grandfather who was more than 80 years old lived with me for a time. He had type II diabetes, with peripheral neuropathy and peripheral arterial occlusion. Regular walking had improved his condition, but after a while he gave up the walks. One day I said to him, “You’ll become an invalid if you don’t keep walking.” He retorted, “I am already invalid,” emphasizing the middle syllable instead of the first. He had been an important man in his career, and had only stopped working two years earlier. Now that he was retired, he didn’t feel worthy. He saw no point in taking care of his health, since he was no longer of any use … in his mind. As part of a family he was very much appreciated and valued. But due to his beliefs about what it means to be a man, that was not enough for him.
Men also feel that their health is defined by what they can do. Such men feel that if they can go to work or do a job and get it done, they are healthy and therefore do not need medical attention. Men are more likely to deny signs of declining health until their health has declined so much the situation is undeniable.
Men tend to push on with what they are doing, regardless of health warnings from their bodies and from others. They think they can “be strong” and “push through”; that they can’t be bothered with health problems or healthcare, because they are working, providing and taking care of others, and have to “get the job done.”
If men are willing to spend money on themselves, it is more likely to be on material items vs. their health. Men don’t want to be told what to do, so they don’t want to see the doctor (a challenging authority figure who will tell them what to do or not to do).
In other words, men who suffer from the “Superman” complex are not likely to see a doctor – not, at least, until they fall to the ground weakened by the kryptonite of a myocardial infarction, ruptured disc or some similar catastrophic health problem.
Possible solution:
I’ve found that the best strategy to overcome negative male conditioning about healthcare for themselves is to appeal to their positive male conditioning. In the short run, to get the man to be a patient to begin with, we need to use these “male” behavior patterns to get the man in question to seek healthcare for himself as a way of fulfilling his duties to others. That works because most men are conditioned (and/or genetically “programmed”) to want to provide for and protect others.
To put it simply, there should be an appeal to the man’s instincts to provide for and to protect others. These solutions usually take the form of a loved one (typically a spouse) presenting the specific idea to the man. The woman implements the solution by getting the man to see that his own healthcare is a necessary part of his role as a spouse, father, son, etc. The woman is asking the man to seek healthcare, not for his own sake, but for someone he cares about.
However, one reaction could be that the woman has rigid beliefs about relationships that could create obstacles to getting results, such as “We’re both individuals, and I have to respect his own path, regardless of how I feel”; “It’s not right to manipulate someone else”; or “It’s not my place to tell him what to do.” Although these kinds of beliefs may seem altruistic and “spiritual,” they actually may be just naïve. If a person really cares about someone else, she will do what it takes to get him the help he needs. This is similar to the principle of having an intervention for addictions. In fact, most men need an intervention to get them to see a doctor. But the intervention can be simple and subtle.
It really comes down to love: if the man does not love himself enough to get help, does he love someone else enough to do it? If not for love, what about out of compassion?
Appealing to Male Behavior
In appealing to love or compassion to get a man to seek healthcare, it is often helpful to know the “love language” of the people involved. Love language is a “pop psychology” system of understanding and improving spousal relationships. It started with the book The Five Love Languages by Gary Chapman. This method works by identifying the predominant way each person receives and gives or shows love. The premise is that many relationship problems arise when one person shows or receives love in a way that is different from the spouse. By knowing the love language of oneself and one’s spouse, many couples can dramatically improve their relationship. This same method can be used to get a hesitant male spouse to seek healthcare.
The five love languages are:
- Words of affirmation
- Spending quality time with the other person
- Receiving or giving gifts
- Acts of service
- Physical touch (not sex)
Many men feel that they show love by giving gifts and/or acts of service. Getting things done on a “honey-do” list is an example of an act of service. Unfortunately, many women don’t feel loved by being given gifts or having chores done. Most women prefer quality time (talking) and words of affirmation. To use love language to get a man to seek healthcare, the spouse should phrase the request in the love language the man relates to. For example, if a man feels that he shows love by doing things, then a spouse can ask him to put “seeing the doctor” on his “to do” list.
If a man shows love by giving gifts, the spouse could encourage him to visit the doctor as his “gift” to her, instead of jewelry or whatever other material items she is used to receiving.
Some men have a prejudice against, or are skeptical of, naturopathic medicine. Such men may be willing to see an allopathic physician, but not an ND. There are a few ways to help change these men’s minds:
- A spouse (or even a child, parent, etc.) can include the man’s prejudice in the appeal. The point is to not try to convince a skeptic that he’s wrong. If he thinks that naturopathic medicine is not “real medicine,” is “unscientific,” “different” and so on, point out that he does many other things that fit the same criteria, and thus, he might as well try naturopathic medicine, too.
- Try to get the man to meet the doctor, either by accompanying someone else who is a patient or by going to a free introductory consultation. During this contact, the doctor should try to allay the man’s concerns. Something I’ve found useful to say goes like this: “Hello, Mr. Smith. I’m glad you came to your wife’s appointment. She tells me you’re somewhat of a skeptic. That’s good. I’m a skeptic, too. Actually, I prefer it when patients are hard to convince. That way, it’s easier for me to see when a treatment is really working.”
- Focus on resolving the health problems of the man’s spouse or child. Wait until the results are dramatic, and the man can recognize the improvement. Then the man can best be approached about getting treatment for himself.
Getting a man to see a doctor is just the first step. Getting him to follow through with recommended therapies, treatments or lifestyle changes can be more difficult. See the accompanying stories for an example and for other love language strategies.
Getting Men to Follow Through with Therapy, Treatment
This is a big subject. Due to space limitations, I’ll discuss just one kind of problem and how to deal with it.
The problem is a common one: A male patient is seen for a musculoskeletal issue, such as pain from a back injury. The doctor prescribes therapeutic exercises, and tells the patient to refrain from performing certain types of movements. The male patient goes home but does not do the exercises, and still performs the restricted movements. This leads to a self-fulfilled expectation that naturopathic medicine doesn’t work.
To solve this type of problem, the doctor may have to dig deeper into the psyche of the patient. Appealing to “doing it for someone else” or using love language does not work. The problems are older, deeper and more hidden. But they usually are still related to a man’s conditioning. It’s just that the conditioning tends to be quite specific: from the man’s father.
Non-compliant male patients often had fathers who “taught” their sons that they had to work hard, make money, be responsible, sacrifice themselves and so on. This conditioning might have taken the form of the father saying these things to the son. Or, it may have been less direct or obvious. The father could have been critical, saying things like: “You never get enough done” or “You don’t do it right,” or variations of these themes.
The father also might have withheld praise and/or affection with or without being overtly critical. This causes the son to emulate the father’s ways in an unending attempt to get love or approval. The child’s reasoning is very simple. He thinks, “If I am more like my father, he’ll have to like me.” The problem with this rationale is that such fathers are usually poor role models for taking care of their own health. They work too hard, don’t relax, push themselves, work when ill or injured, don’t see doctors and so on. Sons of such fathers grow up with the same patterns of their fathers, even when they think they are rebelling or being different. Fathers can be dictating their sons’ health behaviors whether the fathers are still living or have passed on. These issues have to be recognized and dealt with if such sons are going to get results from naturopathic care.
Strategies for Getting Men to See a Physician
The strategies go something like this:
For the woman’s health: “Honey, I really need you to see the doctor and have that chest pain checked out. I know you can handle the pain, but I can’t. I’m worried, nervous and anxious. I’m not sleeping well, and I’m gaining weight because I’m eating out of being stressed. In fact, my doctor says that I’m so stressed, it will be hard to get over these migraine headaches.” When worded this way, most of the time the man will agree to see a doctor as a way to help his spouse feel better.
To provide for the woman’s security: “Honey, if you don’t see a doctor soon and wind up dying, what will I do? Who will take care of me and the kids? You know I depend on you for so many things. I’m not ready to do it all myself. You’re such a good husband; I really don’t know how I would survive without you. By the way, dying wouldn’t even be the worst of it! Something bad could happen to you, God forbid, and I would wind up having to take care of you. What if you were paralyzed, or in a coma? I would hate that for you, but also I wouldn’t be able to handle it. And where would we be financially? We couldn’t afford to hire help, let alone keep the house. We would have to declare bankruptcy, and then we’d be on the street anyway. Think about it. Please see a doctor!”
To show love: “Honey, you know how it worries me that you’re not taking care of yourself. You should see a doctor. What if that chest pain is really a bad heart? You could have an attack, and be gone at any moment. Then where would I be? I love you so much; I can’t bear to think of being without you. I’m too young for that. We have too many years to enjoy together. I don’t want to be lonely and sad, thinking of how much I loved being with you. You wouldn’t want me to be like that, would you?”
If the man answers in a typical male way, like “Sweetie, don’t worry. Nothing is going to happen to me. I’m not going anywhere,” the woman should reply like this:
“I’m glad you’re saying that, but how do you know? You’re not a doctor, are you? You said the car wouldn’t break down, and it did, because you didn’t take it to the shop in time. I’d like to hear the doctor say nothing is going to happen to you. If the doctor says it, I’ll believe it. But please, don’t promise it yourself. You can’t promise that. The only thing you can promise is that you’ll see a doctor.”
I actually ask my female patients with hesitant male partners to script and rehearse parts like this. It’s just as though they were rehearsing for a role in a play. Some patients have to rehearse dozens, even hundreds of times before they are ready to talk with their spouse this way. If rehearsal is necessary, then it serves two or more functions: It leads to results in getting the man to see the doctor, and it strengthens the woman’s sense of self-esteem or self-worth.
Shandor Weiss, ND started the Arura Clinic in Ashland in 1989. Licensed by the state of Oregon as an ND and acupuncturist, he also has specialty training in homeopathy, environmental and body-mind medicine. Dr. Weiss received his undergraduate degree in ecology and environmental studies from Hampshire College in Amherst, Mass., then moved to Berkeley, Calif, to study natural and holistic healing. He completed his education in Portland, graduating in 1988 from NCNM and the Oregon College of Oriental Medicine. Dr. Weiss served as a research consultant to the National Institute of Health’s Office of Alternative Medicine; has written many lay and professional articles on health; and enjoys reaching the public through lectures, teaching, radio and television. As an ND, Dr. Weiss integrates environmental medicine and an ecological model of evaluating patients as an integral part of his practice.
Reference
Centers for Disease Control (CDC): Available from www.cdc.gov/nchs/data/ad/ad315.pdf.
