Many of us are pondering the questions du jour: Should I return to the office? If so, when? Full-time or hybrid? But a return to work isn't the only question I hope you're asking. It's also time to return to your health care providers for essential annual exams that fell by the wayside during COVID-19. And nobody needs a bigger nudge than the men in our lives who countless studies show are less likely than women to see the doctor unless they're really sick. Even then, they might not be candid about what ails them. We check in this week with Dr. Olusola Adegoke, a family medicine practitioner in the east metro, who offers counsel on how to encourage the guys we care about to get those checkups.
Q: Research consistently shows men reticent to see the doctor. I found one ongoing study from the Cleveland Clinic, for example, where only half of the 1,174 adult men surveyed said they get regular checkups, and 72% said they'd rather do household chores like cleaning the bathroom than see their doctor. Why do you think this is so?
A: There's a sense of invincibility, or wanting to relegate their health to the least important thing in their life at that moment. It might feel like another thing or requirement "that I have to do." There's also a mind-set of, "If it's not broken, don't fix it."
Q: But sometimes things are broken, or at least worrisome for men. What are some of the greatest risks for men in avoiding the doctor?
A: Most cases of high blood pressure, for example, are asymptomatic; there are no symptoms. If you don't get regular blood pressure checks, it can become horrible after the fact. But the two huge things I see relate to reproductive health, such as erectile dysfunction (ED) or urinary problem, and mental health. I practice in a semirural community and male patients will say, "Don't tell my nurse." I try to sort through the noise to find out what exactly is going on. They might be experiencing depression, anxiety, marital discomfort. Their wife tells them, "You need to go to talk to somebody."
Q: Does having, or not having, health insurance play a role?
A: Sometimes it has to do with health insurance. With women, health insurance payments are structured so that, if you come in for annual exams that are preventive, they're free. By the time men get to, "I have other concerns," it spills over into a copay and that might be another huge struggle.
Q: What are annual or, at least, semiannual exams you'd like men to get?
A: This is very age dependent. Usually I follow the United States Preventive Services Task Force recommendations as a template to determine the age appropriate exams and screening required by the patient. At 18, we strongly recommend a high blood pressure screening. We also talk about body mass index (BMI), which offers a rough estimate of who is obese, who is overweight, who is underweight and who might need to be screened for diabetes. We offer tobacco and smokeless tobacco counseling; alcoholism and chemical abuse screening, and a screening tool for depression. We begin prostate screenings around age 50 or 55. We always pay attention to family history.
Q: Is this reticence even truer for men of color, or gay men, for example, who might fear that their health concerns will be dismissed or ignored, or that they won't be treated with respect?
A: Based on the current literature and anecdotal evidence, it is truer in these populations. This is most likely due to the lack of representation and historical mistrust between these communities and the health care system as a whole. For example, colon cancer is endemic among people of color so we might do a screening at 45 instead of 50. The question is: How do we best address those concerns? The answer: Relationships and representation.
Q: Does the doctor's gender matter; i.e. are men more likely see a man?
A: I think it might be a factor. Men generally want someone they can relate to and who has shared experiences with them. They also want to be able to discuss some of their vulnerabilities.
Q: Do you find that the woman in a man's life typically makes the call?
A: It is more likely that the women in men's lives make the appointment for a physical, based on some medical concerns or a family history of significant disease. If I see a young guy in his twenties or thirties and the visit is not something required by his company, it's his wife or significant other who made the appointment 90% of the time.
Q: Is that because we start seeing medical professionals so much earlier?
A: A woman's relationships with her health care providers do start much earlier, with a Pap smear at 21; a pregnancy continues to build on that relationship. Men might not begin that relationship until 50 with screenings for cholesterol, cancer, blood pressure and diabetes.
Q: Obviously, some exams can't be done virtually but are some virtual visits better than no visits?
A: A virtual visit has a role to play in the preventive visit. Having the opportunity to get some routine laboratory blood work before the visit will also be helpful.
Q: What's your bottom line for men?
A: Get in for a physical/annual visit. Know your health status, and get a baseline assessment. If you come in every year, I know what your normal is, so the day where something is not normal, at least the relationship is normal and we can build on that.