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Tuesday, March 14, 2000
Home Edition
Section: PART A
Page: A-1

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 visits.

"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 immortal."

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 them.

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 to men.

"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 said.

"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 reproductive years.

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.

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