Tuesday, March 14, 2000
Section: PART A
Men Tend to Avoid Health Care, Study Says
By: Julie Marquis Times Health Writer
An alarming proportion of American men are "dangerously
out of touch" with the health care system, failing to get routine checkups
and delaying care even for potentially life-threatening conditions, according
to a new report.
Three times as many men as women had not seen a doctor in the previous
year and one in three had no regular doctor, compared to one in five women,
according to the 1998 survey of 4,350 men and women across the nation.
A quarter of men surveyed said they would wait "as long as possible" before
seeking help for a health problem.
Funded by the Commonwealth Fund, a social and health care research foundation,
the survey by Louis Harris & Associates is one of the largest and most
extensive to date on men's health care patterns. The findings underscore
a growing gender gap in health care.
Attitudes Play Major Role
Women sometimes are portrayed as the stepchildren of the health care
system because in the past they have been largely excluded from clinical
trials and other research. But in practice, women are far more plugged
into the nation's health system. And researchers found that the difference
is only partly the result of women's regular obstetrical and gynecological
"Certainly men's own attitudes contribute," said David Sandman, the Commonwealth
Fund researcher who analyzed the survey results. "From the point when
they are young boys playing sports, men are taught to 'play with their
pain,' to ignore their symptoms and not to ask for help. I think that
those lessons can last into adulthood."
Perhaps nowhere is men's aversion to the doctor's office more evident
than in preventive care. More than half of males in the survey reported
that they did not have a physical exam or a blood cholesterol test in
the past year. Six of 10 age 50 or older were not screened for colon cancer,
while four in 10 were not tested for prostate cancer. Both diseases can
be life threatening if not detected and treated early.
Dr. Richard David has seen lives tragically cut short. The Sherman Oaks
urologist recalled the case of a man in his 60s who lived alone and hadn't
been to the doctor since he was a child. The only reason he came to David
was that he could no longer walk.
By then, his prostate cancer had spread too far to be cured. Caught early,
the disease is curable in 70% to 80% of cases, David said.
What keeps men away from the doctor's office? In general, says David,
"men don't like to leave work, plus guys don't like to talk about personal
things, and then there's this machismo effect of being infallible and
A lot of men show up only because their wives or daughters insist. In
the case of prostate screenings--even free screenings--"at least half
the men come in with women holding a gun to their heads," David said.
His observations appear to be borne out in the survey, which found that
a fifth of men were "not at all" or "not very" comfortable discussing
health issues with a doctor. Moreover, men were less likely to seek care
if they lived alone, presumably without a close family member to prod
Marketing researchers have known for some time that women tend to take
charge of health-related decisions in the household. And in the past decade,
medicine has strived to accommodate women's specific health concerns in
research and practice.
Yet men's lack of participation in the system has gone largely unaddressed
and they have not been encouraged to take charge of their own care. This
is particularly significant because men die an average of six years earlier
than women and are far more vulnerable to heart disease, chronic liver
disease and violence, according to the report.
In fact, the Commonwealth researchers set out to map female health care
patterns, and only looked at men initially by way of comparison.
Then "a lightbulb went off," Sandman said. "We realized we were sitting
on a gold mine" of important information about men's health.
Health experts said Monday that the findings argue for stronger outreach
"I think we've given a very appropriate focus to women's health in the
past several years. . . . there's been a greater sensitivity on the part
of providers to diseases more common in women [such as] depression and
arthritis," said Dr. Jonathan Fielding, director of health services for
Los Angeles County. But, he said, "I think there hasn't been the same
big push in men's health."
The survey suggests that physicians are partly to blame. Researchers
found that doctors often fail to counsel male patients during visits--consistently
less than they advise women--on such matters as diet, smoking and exercise.
Even in "this day and age of Viagra," doctors are particularly remiss
in offering counseling on sexual health and emotional well-being, Sandman
"It's hard to say [why]," said Sandman, adding that perhaps it is because
most doctors are men and they themselves are uncomfortable raising the
topics. Lack of Health Insurance Cited.
Not all the barriers men face are psychological. Three in 10 working-age
men lacked health insurance at some point during 1998, and those men were
far less likely than others to receive health services. While women face
insurance barriers as well, they are more likely to be covered through
the Medicaid program for poor families, Sandman said.
In some cases, cultural and economic factors combine to isolate men from
the health care system, researchers found. Latino men--45% of whom lacked
health insurance--were twice as likely as other men not to have seen a
physician in the past year.
The Commonwealth researchers found that the gender differences in use
of health care services could not be entirely explained by women's tendency
to seek care for obstetrical and gynecological needs such as childbirth,
Pap smears and mammograms. The divergences in behavior between men and
women are less pronounced with age, but they continued well past women's
Some physicians suggested that women may be conditioned through their
experience as young women and mothers to make regular physician visits,
but men may never develop such ingrained patterns.