I start this blog with an apology. I am about to make some sweeping generalisations, which is an activity generally frowned upon in these days of inclusivity and political correctness; and the nature of the generalisations involves some ideas about the difference between men and women which some readers may find inappropriate. I am also, unusually, basing my blog far more on my own experience (as a GP, but also as a wife, mother, friend, daughter, teacher and so on) than on hard scientific facts. This is partly because there are few hard scientific facts to draw upon! Anyway, enough of the explanations. So, what do I mean when I ask the question “Why do men hate going to the doctor?”.
Men get ill – of course they do. Common sense tells us that they are just as likely to be ill as women, and the statistics tell us that they actually get ill more than women do. You only need to see a man bravely battling through the horrors of “man-flu” to convince yourself that men are no strangers to suffering. But there is a big difference between a man weakly asking for another helping of lightly poached eggs on toast from under the duvet in the living room, and a man booking an appointment with his doctor and (wait for it) actually turning up for that appointment and (wait for it) actually telling the doctor the truth about why he is there.
Glancing down the list of this afternoon’s patients (I have just finished a fairly standard, book-on-the-day NHS session) I see the familiar pattern of patient demographic. Lots of children, lots of women, hardly any men. In particular, hardly any men between the ages of 30 and 60. In fact, when a 45-year-old man enters through the front door of the surgery, my first thought is to wonder whether he is lost. Plenty of days go by when I don’t see any men patients at all – and I consider myself a true generalist (I have no special interest in women’s health, for example). I get the idea that men patients might rather see a man doctor, but my male GP friends reassure me – the male patients aren’t avoiding me to see a male GP, they just aren’t coming in at all.
So, why not? There are a few theories, but none (to my mind) which stands up to careful scrutiny. Some people have suggested that men can’t get out of work to visit their GP, whereas women find it easier. Sorry, but I don’t buy this. Particularly when all the women I know have just as many commitments during the day as the men I know, and when GP appointments are available outside of normal working hours. And I can’t imagine a boss saying “You need to leave early to see the GP? Well, if only you were a woman I would have said yes, but as you’ve got one of those pesky Y chromosomes I shall have to decline your request”.
There’s another argument which suggests that men intrinsically find it more difficult to ask for help than women, because society apparently values masculine strength and bravery highly and considers that seeing a GP is an admission of being “not strong” and “not brave”. The author John Green, in his hugely successful book “Men are from Mars, Women are from Venus”, makes a similar suggestion – he argues that “Martians” will tend to try to solve all their problems themselves, rather than appearing weak by revealing the problem to others; whereas “Venusians” actively enjoy the social discourse of shared problem-airing and problem-solving. I’m not sure where I stand on this one; I think, of course, that true strength and bravery is shown by individuals taking the first step towards change by asking for help, whether men or women.
Maybe, argue other people, we as a society do not encourage men to care for themselves and to exhibit a nurturing nature generally; men growing up are far less likely than women to ask questions about the well-being of another individual and so maybe, it is thought, they become less good at questioning whether they themselves are in fact “OK”, and placing their own health high in the priority list. This one may hold some weight – from the earliest days at medical school it became very apparent that, if you wanted to extract a genuine medical history from a man (an accurate, informed account of illnesses and treatments, past and ongoing) you had to hope that his wife would be there. I have never seen a man produce a laminated list of his wife’s medications and allergies, whereas the reverse is par for the course; I have, however, witnessed countless men turn, apparently baffled, to their wives to clarify what they are taking and why. Memorably, I asked a man with a huge, fresh median sternotomy scar (the sort left by open heart surgery) what operation he had had and why – luckily his wife knew the answer, whereas he had forgotten. So, do men care less about their own health, or do they learn to hand over responsibility for it to someone else?
Another argument suggests that men find going to the doctor intrinsically more scary than women do. I have certainly seen men patients hover nervously in the open consulting room door, glancing suspiciously at the patient’s chair as though they are worried I have, as an elaborate practical joke, booby-trapped it with a whoopee cushion or an ejector seat mechanism. I have practised my best scary doctor face in the mirror this morning, and, to my mind at least, managed an epic fail to look anything like intimidating. So, if they are not scared of me, what are these men scared of, exactly? Being given bad news? Having to undress? Needles? All perfectly understandable, but surely no more or less scary for a man than a woman? And some of my patients routinely face hazards at work that would have me quaking in my boots (firefighters, police officers, soldiers, primary school teachers, etc.) and are in no way cowards. (By the way, for the record, I am not scary at all!)
Another argument suggests that the GP setting is uncomfortable for men – too feminine, too public, too intense. Certainly the vast majority of people in a GP surgery setting are likely to be women, including (these days) the doctors. I think it is certainly true that women patients appear entirely comfortable in the waiting room- they will chat happily to the receptionists and fellow patients, often calling them by name and sharing details of what has brought them in to see the doctor. They usually arrive prepared, with a Kindle and snacks for the kids, and merrily settle in to the experience. Men patients, however, tend to approach the front desk furtively, and offer as little as possible in the way of communication with anyone until it is time to be called into the doctor. They sit in silence, staring at the ceiling or the floor, and don’t speak to anyone if they can help it. I remember two very similar-looking men sitting in a waiting room, next to one another but without talking, who I later realised were brothers.
Maybe, some suggest, men just underestimate their symptoms. I recall in my junior doctor days, watching in astonishment as a man waddled into A&E like a bad John Wayne impersonator, before reluctantly dropping his trousers and showing me a massive hernia – basically a section of his bowel had fallen into his scrotum, and he had what appeared to be a large melon where his testicle should have been. He had wanted to finish watching the football, and hadn’t wanted to bother anyone at all, but was eventually persuaded to come down by –guess who? That’s right, his wife. Another man, in dermatology, removed his shirt to show me his psoriasis – I am not exaggerating when I tell you that dead skin fell to the floor in quantities that I had to sweep up afterwards; he just wondered if there was a cream or something that he could use because he was about to get married and go on honeymoon and – guess who? That’s right, his fiancée – thought that there must be something that could be done before the sunbathing started.
Men can sometimes be creative, too, when it comes to the description of their symptoms. I have heard a man patient describing the pain of a massive heart attack as “a slight twinge in the chest”; a man patient asking me to look at his “slightly red” toe then showing me a horribly infected, ulcerating, decaying foot; the list goes on. The most telling, though, is what I call the “hand on the doorknob” question – this refers to the real, hidden, reason why the patient has really attended, which they save to mention as they are physically poised with one hand on the doorknob and about to exit the consultation room, and only when they have decided they can definitely trust you. Great examples of “hand on the doorknob” moments from men patients have included the conversational “By the way, I rang the Samaritans last night because I have bought a shotgun and had decided to blow my brains out”; the question from a married father of three who regularly travelled to the Far East on business as to whether he could be vaccinated against various sexually transmitted infections prior to his next trip, as he plannedon frequenting some gay massage parlours; the nervous statement “Oh, and one other thing – there is blood in my sperm when I ejaculate”. *
Whatever their reasons, we must not allow men to continue to feel reluctant to see the doctor. At the moment, one in five men in the UK will not make it past the age of 65. Some of the biggest killers of our men, including heart disease and cancer, can present with symptoms that are initially so subtle that they can be easily ignored – high blood pressure, which can lead to strokes and heart disease, usually has no symptoms at all. Maintaining health in the men in our lives needs a proactive approach - to head off problems before they occur, or to spot them early enough to make curative treatment much easier. Most of the routine screening programmes in our NHS are geared towards women, but surely an annual wellness check for all men over 40 makes perfect sense? Talk to the men in your life, ladies, and persuade them to come and see us for a once-over – they wouldn’t drive their cars without an annual MoT and service, so why should their bodies be any different? It always makes me smile when a man comes in for a check-up and, when I ask what made him decide to come, he says (invariably) “Oh, the wife made me.” I then think to myself “Good for you, missus. Good for you.”
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*By the way, this is a very common problem and almost always nothing to worry about – check with us just to be on the safe side.