Are there enough men in your surgery? Alan White, professor of men’s health at Leeds Metropolitan University argues that if there are not, then it is down to doctors to work out how to get them there. It may be cheaper in the long run.
Your third patient of the day is a man in his mid forties, he comes in and tells you that there is nothing wrong with him, but he wants a health check. Is that a strange event?
As you examine him he tells you of his family and work problems that he has been feeling anxious that he is not coping with the pressures he is facing. He also talks of his desire to lose some weight and to be a bit more active. Is this a strange event? A middle aged man, not an old man or a young boy with his mother, who is not actually poorly, who is wanting a health check and is willing to tell you that he has emotional problems and is wanting to improve his health?
What is his background? Is he a manual worker who has taken time off from his work where there is competition for places and there is no flexitime, to come and see you for this check up?
Look around your waiting room, who do you see? Is it an even mix of young and old, male and female, from different ethnic groups and from different socio-economic backgrounds? Or does your practice seem to be missing the most vulnerable group in society until they are already poorly and needing treatment?
If you look at the figures you would certainly expect middle aged men from a working class background to be there in greater numbers than any other group. For all the disease states male manual workers have a greater chance of being affected and can expect both a shorter lifespan and a reduced healthy life expectancy. In a city in England there is an incredible 13 year difference in life expectancy between men living in the leafy suburbs as compared to a much less affluent district!
The risk of developing all the cancers that can equally affect men and women will occur most often in men, men will die of most common disease states before women and men are at a significantly higher risk of death or disability as a result of accidents and coronary heart disease. Men now have about the same risk of developing prostate cancer as women have of developing breast cancer, but many still do not know what it does or where it is in the body. If you can identify a man with erectile dysfunction, chances are you will also diagnose the early stages of cardiovascular disease.
You would also expect to see a number of men with relationship or emotional problems due to the continuing rise of divorce, job losses and other stressful and stigma creating failings in current society. All contributing to the four fold difference in the suicide rate among men and the fact that in some European countries suicide is the leading cause of death in men under 44 years.
With the realisation that more men are now overweight than women you could also expect to see men with diabetes, hypertension, and hyperlipidaemia as a result of the metabolic syndrome. The fat will also have created problems of erectile dysfunction and have increased the risk of prostate cancer, stomach cancer etc. They are also more likely to require prescription drugs.
You should also expect to see men from the ethnic minorities, with men from South Asia with a four times higher risk of diabetes and men from an African Caribbean background being three times more likely to develop prostate cancer.
If your surgery does not have these men what is keeping them away? It is not a lack of interest in health, as most studies actually show that men are concerned about their well being. Being healthy enables them to work and to provide for their families.
Is it that men are not aware of their health problems? We now have the great Pele talking about erectile dysfunction, Stirling Moss discussing the problems of prostate cancer, Robbie Williams extolling the benefits of examining your testicles for cancer. Newspapers are starting to carry lead stories about men’s health. Soap operas are presenting story lines with male characters developing health problems.
There has just been another men’s health week (June 13 – 17) in which we saw all sorts of activity and press coverage across Europe on the problem of men being overweight and inactive. The fourth World Congress on Men’s Health is being held in Vienna this September and there is a growing membership of the European Men’s Health Forum
All these should result in men and practitioners becoming conscious of the need to see men presenting for regular health checks. Most of what they suffer from could be identified earlier by simple screening of cardiovascular status, blood glucose and lipid levels and a measurement of their waist [above 102 cm is now seen as a clear indicator of high health risk] and a discussion of their lifestyle. If this is coupled with a careful record of their family medical history then a fairly clear indicator of their health status can be obtained.
If these middle aged men are not in your surgery, where are they? Do they not know that they have all these problems or is it that they are not very good at getting to see you? It appears that men tend to see the family doctor as a very busy person who shouldn’t be bothered unless they are really poorly and going when they are well is risking being seen as a time waster.
So how do you get them to this health check? Again experience shows that men will turn up if they are written to and given an appointment requesting that they attend. Giving the date and time is very important, a letter asking them to make the appointment will not result in many doing so, as that requires them to contact the clinic, which is a task not many men relish! It is also easier for the working man to take an invitation to his manager and say that he has been told to go to the doctor and therefore needs time off work.
Another way that has found to be extremely good at identifying men with undiagnosed problems is to go to the men rather than waiting for them to come to you. Having trained nurses going into factories, sport centres, shopping centres, even public houses and barbers has given the men an opportunity to be screened without the trauma of making an appointment and taking time off work to go for a consultation.
Men’s health is now a reality and it will have a direct impact on the family doctor so you need to ask yourself, ‘Are there more men in my surgery’? If there aren’t then there should be! Perhaps you need to go and find them; it may be cheaper in the long run.
