The Real Reason Men Don’t Seek Medical Care From Doctors

Why do men avoid the doctor’s office? Many things in life and healthcare aren’t set up to be friendly to men, who are socialized to manage risk, to hide pain and vulnerability, and to be self-sufficient in the face of challenge, while providing for their loved ones, and getting to work on time. Even things that flex to accommodate costs, or outdated clinic designs that don’t accommodate evening or weekend schedules, cause people of all genders to postpone medical treatment for a short period of time. However, for a longer period of time and with more severe illness, it is men who typically delay needed healthcare and present to the provider with a greater severity of illness. So what can we do to support the health of men? To start, we need to design healthcare that is designed for men.

Why It Matters

Health issues that are manageable if treated early can become serious health emergencies and major distractions from other areas of your life if they are delayed for months or years. Early detection and treatment really matters for men, because good treatment can be fast, simple and inexpensive. By the time symptoms appear or get worse, men have often waited too long and what was a simple medication or short treatment course has become a complex, costly and time-consuming issue that involves urgent care, hospitals or specialists.

Many people think that prevention is something extra. It’s not. Prevention is risk management, and being a good patient means taking care of small things so they don’t become big problems. Office visits are a great time for your clinician to find “hidden” health risks and make a few adjustments here and there to keep you functioning on a day-to-day basis. During routine visits, your clinician can monitor and treat your blood pressure, cholesterol, and glucose levels to help prevent heart events and stroke. Keeping up on vaccinations is also an important way to prevent serious health issues. Even advising patients on weight and sleep can help prevent a host of other problems. By skipping routine office visits, men are missing out on these small changes that could make all the difference in their health.

Mental health and substance use are related patterns of behaviour. Many men are reluctant to acknowledge stress as anxiety or depression and instead report a variety of physical complaints, such as fatigue, irritability, headaches, back pain or sleep disturbances. Some men are hesitant to seek mental health care because of concerns about stigma, because they feel that seeking mental health care makes them appear weak, or because they fear that they will lose control of their treatment plan. A delayed entry into mental health care can lead to a late treatment phase, and may also limit the range of interventions that can be used to treat the man. In addition, a late presentation to mental health care has been associated with increased risk of substance use, accidents and injuries, relationship problems, and work related problems.

The way in which communication fails can make the first visit worse than it needs to be. The many problems that need to be discussed at the first visit can make patients who have not been in a clinic for years feel lost and unwelcome. Those involved in patient care must be aware of how their words can be misinterpreted. Future risks must be related back to how they may affect current quality of life such as energy, actual stamina, sexual health, sleep, work performance, etc. And how these factors keep the patient-focused dialogue on track.

So why don’t more men come to the clinic? Most importantly, getting to a clinic is not easy for many men. As with many aspects of health care, there are many enumerated “barriers to care” to which a clinic may try to address, but each one has its own weight and each one can isolate men from care. It is not just that a clinic may be open during business hours, but also hard for a working man to get to, with long waits for appointment and then in the waiting room. And even if a man wants to come to the clinic for his health, he may be stopped by fear of not knowing what it will cost if he is uninsured or underinsured.

The delays in regular care can have unintended consequences on the health system as a whole. By postponing needed care, men end up receiving care in Emergency Departments, Urgent Care centers and hospital-based clinics, which affects costs and challenges providers, payers and employers in their planning. While health outcomes for these men may be equivalent to those experiencing timely care, their experience of and access to care may be different than their more affluent counterparts, particularly those from lower-income and marginalized communities.

Who It Affects

Younger men think they are fine until something breaks. Many younger adults do not realize that they have a serious illness until much later in life. To prevent years of lost preventive health care for this group of patients, it is important for young men to establish a primary care physician. In addition, younger men who only use health care services to treat injuries, illnesses and conditions will miss out on.

This is the demographic that puts off medical appointments. People who delay medical appointments are typically middle-aged men with work and family responsibilities. They are 30s to 50s years old and put off medical appointments to deal with work and family responsibilities even when symptoms are intermittent and mild. But this is a time in life when men are developing chronic diseases such as weight gain, high blood pressure, sleep problems, stress and early signs of metabolic disease. Delaying treatment during this time can lead to more severe health problems later in life.

Men over 50 may view their health issues as inevitable aging. However, pain, fatigue, breathing difficulties, low libido, and other symptoms don’t have to be suffered. While the process to peak function may be longer and the options fewer for persistent and severe symptoms, optimal health is attainable.

Many men working in physically demanding and rigid schedules such as construction, transport, manufacturing and primary production and those working shifts experience great uncertainty with their work hours. This means that when they need to visit their doctor, attend hospital or have surgery, they are likely to loose pay, risk loosing their job or fall behind with work. Such men often have little chance of workplace prevention and need help to manage these challenges at home.

Healthy men and boys from marginalized or underrepresented populations face additional barriers to accessing quality health care. These barriers may be related to provider and facility levels as well as patient-level barriers such as transportation and cost. Language and negative prior health care experiences are also concerns that may cause some men and boys from these populations to perceive the health care system as unwelcoming or even unsafe, leading to delayed diagnosis and advanced disease at time of presentation.

Providers see men at different stages of the disease. Some men report and address symptoms promptly, while other men underreport or fail to recognize their symptoms and present with serious complications. As a result, diagnosis and treatment planning can be particularly difficult and time consuming. Providers must then spend considerable time educating the patient and his family about the disease process, establish trust, and then jointly make medical decisions.

Late care in advanced illness has many effects on health systems, employers, and families. It reduces productivity and leads to many unplanned absences in the workforce. Families bear significant costs associated with late care, shouldering the responsibility of caregiving for a loved one who is dying. Employers and payers bear costs as well, as the potentially avoidable serious illness becomes emergent illness. In addition, families experience many often invisible effects of late care. For instance, partners or parents may delay treatment until acute complications develop.

What Changes

• Design care pathways that meet men where they are: flexible hours, telemedicine visits, and workplace clinics reduce practical barriers and make it easier to access routine care without sacrificing work or family responsibilities.
• Shift communication and practice style to build trust: clinicians who use plain language, acknowledge concerns about masculinity and independence, and practice shared decision-making can improve engagement and adherence to treatment options.
• Invest in community-based outreach and navigation: peer-led programs, faith- and community-centered clinics, and targeted messaging can address cultural stigma and distrust, increasing early care seeking and follow-up.
• Align payment and policy levers: insurers and employers can support preventive care by reducing out-of-pocket costs, reimbursing telehealth and team-based care, and providing paid leave for medical visits to lower financial disincentives.

Why It Matters (continued)

Developing interventions to encourage men’s use of health services requires an understanding of the reasons for this behaviour. Many men avoid disclosing health concerns due to embarrassment or a sense that they have failed in some way, often as a result of cultural and societal expectations of masculinity that suggest it is ‘unmanly’ to report health concerns. The cultural expectation of stoicism plays a significant role in this, portraying the ‘perfect’ man as self sufficient and unconcerned by pain or illness. This can lead to men downplaying their pain and consequently providing health care providers with a distorted view of their health problem. This study sought to investigate the reported duration of pain experienced by men and the accuracy of this self reported data.

The reasons why men are less likely to participate in routine health surveillance also relate to the relationship between health literacy and communication styles. Research shows that many men have limited knowledge and ability to perform health actions for reducing future health problems. While much health content is written and delivered in a female focused setting and image, clinicians in health promotion roles need to be aware that adopting a goal-oriented, solutions-focused communication style may be more effective than a health-oriented approach when interacting with men. A focus on physical health, work ability or other aspects of life that are important to men as partners and fathers can encourage them to participate in health promotion and illness prevention programs and activities.

Practical barriers to cancer screening and treatment for men are often time-sensitive: the hours that a clinic is open, a patient’s obligation to care for his children, the forms of transportation available, the cost of clinic visits and of cancer medications, to name a few. Many of these barriers are perceived as reasonable by the uninsured or underinsured man. But online scheduling and extended hours at health department clinics and low-cost community clinics can easily overcome these perceived barriers if made known to patients.

Clinical Decision-Making Considerations

The challenges of late evenings in clinic for men with prostate cancer issues are many. It is unlikely that treatment will be needed immediately. However, men are waiting and in need of help. It can be challenging to make decisions for men who may not be ready for change. Therefore, it is essential to share decision-making with patients, outlining various options, explaining both benefits and potential side effects, and relating these to the man’s priorities. Offering treatments in a stepwise fashion, from less invasive to more aggressive or invasive, can increase acceptability of the latter.

Screening and cancer prevention strategies should be presented within a health promotion framework focused on helping men and their partners maintain strength and independence. Clinicians can connect the dots between different cancer risks and issues that are meaningful to most men, such as having enough energy to play with his children, safe and optimal work performance, optimal sexual function. Abstract information about risk is not enough to inspire men and their partners to engage in healthy behaviors.

System-Level Implications

Avoidance of medication management and chronic disease management can be addressed through system fixes. Our reimbursement models currently support reimbursement for episodic, procedure-based medical service that does not support proactive, prevention-oriented health care. This type of reimbursement does not reward preventive or outreach efforts alone, nor does it support delivery of care by a solo physician. However, value-based payments could motivate providers to move in this direction, particularly by supporting team-based care that includes nurses, health coaches and community health workers to conduct proactive outreach and follow-up with patients, especially those who suffer from chronic illnesses or are on medication that needs to be fine-tuned, monitored or managed on an ongoing basis.

Interventions in the workplace and workplace policies can promote healthy behaviors for men. Workplace interventions such as paid sick leave, on-site primary and/or cancer screening, and reimbursement for screenings can reduce financial barriers to health care for men. Media campaigns can normalize men’s health care visits and model healthy behaviors for men.

Forward-Looking Perspective

There are several promising trends emerging for the future of men’s health. Firstly, increased use of digital technologies, such as telemedicine and remote monitoring, can lower access barriers for men if developed with men’s perspectives taken into account. Secondly, community-based health programs that link health services with other organisations that men currently use and trust, can help to rebuild men’s sense of control and their trust of the health system, which has been eroded in recent years.

Developing additional strategies for conveying information about the significance of gender and masculinity-related health issues to clinicians; education and training for clinicians on effective communication of masculinity-related health issues to patients and families; and cultural competence training to address the needs of patients from diverse backgrounds. Ensuring that all patients have comprehensive insurance for quality cancer care, and addressing all other financial barriers to prevention, screening and treatment that are unnecessary and unfair.

Why do men avoid health care? By changing the health care environment to be accessible, relevant, and respectful for all individuals, “men” can seek health care earlier and experience better health outcomes. Health messages and provider behavior must change in order to include men of all identities and experiences.

References:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7337231/