Melvin Small, a 36-year-old Dorchester man who works as a parking lot cashier, has your basic guy-thing about going to the doctor.
“I’m not really into doctors and stuff like that,” he says. When he finally does go, he asks no questions because he doesn’t want to hear anything bad. “I let him tell me,” he says.
His wife, on the other hand, “goes a lot and asks lots of questions,” he adds, laughing. “If her finger hurts, she sees a doctor. She wants to know what’s going on.”
The conventional wisdom is that men, poor hapless souls, just don’t take care of themselves. And there’s some truth to that.
They’re less likely than women to see a doctor when they have chest pain, according to a survey being released today by CNN and Men’s Health magazine. In fact, one-third of men say they wouldn’t see a doctor right away even if chest pain was severe.
They’re also less likely than women to see a doctor promptly if they have shortness of breath, another sign of potential heart trouble, the survey shows.
In fact, men are less likely to go to the doctor, period, according to the National Center for Health Statistics, which says women make 471 million office visits a year to men’s 316 million. That’s 3.5 visits per year per women and 2.4 for men.
But the question is, does it matter? Are women really better off for all that contact with the medical system? Are men truly worse off for their avoidance of doctors?
Women do live longer than men – by an average of 5.6 years. But is that because they see doctors more often? Or is it female hormones, which until menopause, protect women against heart disease, the leading killer of both men and women? Or is it something else?
If men were truly neglecting their health, you’d predict a number of things; for example, they’d be expected to have cancer that is more advanced at diagnosis, at least for tumors for which there are early-detection tests.
Last week, we asked National Cancer Institute biostatistician Brenda Edwards, to check out the hypothesis that men are diagnosed at later stages of some cancers that affect both sexes, including tumors of the lung, colon-rectum, bladder, kidney, pancreas, skin (melanoma), stomach, oral cavity, and pharynx.
What she found was surprising: there’s little difference between men and women when it comes to what stage they’re diagnosed with cancer. Men do get more cancer overall, she says, and partly because of that, are more likely to die of it. But men also smoke more, and they may also be out in sun more at work or play and may encounter more carcinogens on the job.
Okay, but what about heart disease? Surely all those pot-bellied, heavy-smoking, out-of-shape guys must have more advanced heart disease than their conscientious wives by the time they finally see a doctor.
Nope. It’s women whose heart disease is typically diagnosed at a later stage, says the federal Centers for Disease Control and Prevention in Atlanta. Because they’re diagnosed later, women are more likely to die after a heart attack or a procedure called angioplasty to open clogged coronary arteries.
Part of that is that doctors often miss women’s symptoms, which can be different from the classic “male” symptoms.
While men having a heart attack often feel as if there’s an elephant on their chests or have pain radiating down their arms, women often feel pain in the upper abdomen and have nausea, sweating, and shortness of breath, says Dr. Marianne Legato, professor of clinical medicine at Columbia University College of Physicians and Surgeons and a pioneer in the new field of gender-specific medicine.
So does all this mean men are right to eschew doctors?
Not at all. In fact, whether or not men could live as long as women if they took better care of their health, they might feel better, physically and emotionally, if they shed their resistance to seeking help.
At New England Medical Center in Boston, Dr. Sheldon Greenfield and psychologist Sherrie Kaplan, director and co-director, respectively, of the Primary Care Outcome Research Institute, have studied audio tapes of how men and women behave at the doctor’s office. The differences are striking.
Overall, the average man asks few or no questions in a 15-minute visit, whether the doctor is male or female. The average woman asks six or more.
It’s worst when men see male doctors, says Kaplan. It’s a “businesslike, gruff, clipped encounter. . .Men don’t complain. We women say, ‘Wait a minute, you interrupted me.’ ” When men see female doctors, they do a bit better – they tend to ask a couple of questions.
Women probably learn to be assertive with doctors because they have more practice. They’re told to see gynecologists regularly from adolescence on and they take their kids to the doctor and hammer away until they get the answers they need.
That assertiveness pays off. In Kaplan’s studies of people with diabetes, hypertension, or arthritis, patients who ask more questions and get more information fare better medically.
Being more willing to talk to a doctor can help in other ways, too. “In terms of quality of life, men are often worse off than women,” says Dr. Martin Miner, an internist at Harvard Pilgrim Health Care of New England in Swansea, who is studying reasons why men don’t go to doctors.
“Men have all sorts of intimacy issues,” he says, yet don’t know how to talk about feeling bereft when children grow up, or feeling dissatisfied at work or not being close to their wives.
That clamming up doesn’t help. While women are more than twice as likely to suffer from major depression, statistics show that men’s emotional pain often shows up in hidden or not-so-hidden depression, substance abuse, and suicide. Indeed, men are about four times as likely as women to commit suicide.
Over the course of a lifetime, equal numbers of men and women – roughly half in each group – have some kind of psychiatric disorder: depression, anxiety, or substance abuse, says Ron Kessler, a sociologist at Harvard Medical School. Yet a 1991 Rand study showed doctors miss 67 percent of depression in men because they’re looking for “feminized” symptoms such as crying, not the irritability and anger that men often exhibit.
The bottom line is that many men are hurting – physically and mentally – yet they don’t seek help. “Men feel less virile and strong if there’s something wrong with their bodies. It’s so sad. They don’t give themselves permission to even explore their concerns,” says Miner.