I scored a small victory with my husband, which I'd like to share. It took persistence, subtle cajoling and, I'll admit it, some outright nagging, but I got Len to go to the doctor – and more than once. That's no small feat considering only 39 per cent of Canadian men go for a physical examination on a regular basis, according to a survey by Ipsos-Reid. What's more, 22 per cent of men say they have not been for a checkup in at least five years. Dr. Mel Borins, a family physician in Toronto, adds that many men "have to be on their deathbeds" before they’ll make the dreaded trip.
What is it with men and doctors?
Family physicians say a number of factors keep our mates from the doctor's office, including fears of the unknown (What if there is something wrong with me?) and of medical procedures (Will I have to have a rectal exam?), a reluctance to ask for help and a mixture of denial and apathy (I know I'm fine – no worries). "Most women see their doctors regularly during their reproductive years to talk about birth control and have Pap tests and breast examinations, but men don't develop the same relationship," adds Dr. Alan Katz, associate professor for the departments of family medicine and community health sciences at the University of Manitoba in Winnipeg.
My quest to get my guy, who is 44, to see his physician regularly began five years ago, after our second child was born. I had broached the topic before, with no success, but somehow the arrival of another child made me think more seriously about Len's health. A close girlfriend shares the same situation. She says she booked an appointment for her husband to have an annual checkup while she was pregnant with her second son, who is now six. He did go once, but she doesn't think he's been back since.
The pivotal "aha" moment for me came when I was standing in our kitchen with our daughters underfoot. I had just finished a telephone survey on health care and as I put the phone down and looked over at our girls, I thought, We have two little children who are completely dependent on us. They want their mom and dad to be around for a long time. I want my husband to be around – and healthy – for a long time, too. It was then that I made it my mission to get Len to the doctor. (I quickly learned that getting kids to the doctor is much easier, mostly because they don't make car seats with harness restraints for grown men.)
My plan was to ask Len every couple of weeks – often sweetly, but sometimes with sarcasm – if he had made "that appointment" yet. It took numerous prompts and about two months just to get him to write "Kathryn says I should phone the doctor" in his day timer. By the time Len had been for one physical, which was about 10 months after I began my efforts, it was time to start planting the seed for his next visit. But, hey, at least now he goes for regular checkups (OK, maybe not regular but at least once every 18 months or so) – albeit with my ongoing encouragement.
Page 1 of 4Pushing the subject
I upped the ante last summer when my best friend, Tara (who works in health care), asked me if Len, whose mother died of colon cancer at age 56, more than 10 years ago, had gone for a colonoscopy yet. Tara had also lost a parent to colon cancer, and we discussed the importance of early screening for people with a family history of the disease.
I broached the subject with Len while we were driving up to the cottage one Friday night last summer. (The car is a good place to have these conversations with your man; it's tough for him to feign a sudden urge to mow the lawn when he's at the wheel.)
"Hon, does your doctor know about your mom, and has he ever mentioned that you should have a colonoscopy?"
"Yup and nope." (Men can be awfully concise, can't they?)
"What about your brothers – have they been?"
Len shot me an incredulous look. "How the heck would I know? It's not like we get together for a beer and I say, 'Hey, have you had that test where they put the garden hose up your butt?'"
Making it a habit
About six months and a dozen reminders after that car chat, Len did talk to his doctor about colon tests – a conversation that he admits was easier because he had started to go for those regular checkups. (Chalk another one up for the ladies.) Len did the fecal occult blood test, which is commonly recommended in place of a colonoscopy for both men and women under the age of 50 who are at an increased risk of colon cancer but are not showing symptoms of illness. (The result was negative.) It was a relief to both of us to have this taken care of, and to know that Len's healthy.
After talking to family physicians from across Canada about what keeps men from visiting the doctor, I asked Len why he didn't make the effort for so many years. This is a man who gladly puts his daughters’ hair in ponytails and books a medical appointment if their cough lasts more than four days. Could going to the doctor himself be too much of a stretch for his masculine mind?
"For me, it was a combination of denial, being busy with life and not making it a priority," says Len. "I would always tell myself, There's nothing wrong and I'll have to take time out of the workday to call the doctor and then go to the appointment. But once I went, it was no big deal – 15 minutes to make sure your health is OK. I can do that ... but keep reminding me or I may not go."
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What to expect: A man's annual checkup
20s and 30s
• Review of general health. (The doctor will ask about lifestyle habits, such as sex, smoking, drug use, alcohol consumption, diet and exercise.)
• Examination of the head and neck, focusing on the eyes and ears, and lymph nodes in the neck
• Blood pressure test
• Check of heart with stethoscope
• Measurement of height and weight
• Determine body mass index (BMI)
• Examination of the abdomen for hernias
• Questions about changes in the scrotum, genital and anal regions (Yup, the doctor is simply asking.)
• Testicular exam, if there's a concern, or a history of testicular problems
• Urine test or swab if patient is at high risk of having a sexually transmitted disease such as HIV or hepatitis
• Checks of cholesterol levels through fasting lipid profile if at high risk for heart disease
• Screening for depression using standardized form, if there's an indication that the individual may be depressed
• Update of tetanus shots if necessary (every 10 years)
• Annual flu shot
TIP: "In a man's 20s and 30s, the focus is on talking about lifestyle and habits, and encouraging individuals to make changes such as exercising, eating healthier and quitting smoking to prevent the onset of illness," says Dr. Vinita Dubey, a physician with Toronto Public Health, and coauthor of the "Preventive Care Checklist Form," which is used by doctors across Canada to conduct physical examinations.
Added to the 20s and 30s list is:
• Colon screening (fecal occult blood test, sigmoidoscopy or colonoscopy) if at higher risk of colorectal cancer; for example, if a parent or sibling had it
• Fasting lipid profile now done at least every three years
Added to the cumulative list is:
• Annual or biannual colon screening (fecal blood, sigmoidoscopy or colonscopy)
• Whooping cough (pertussis) vaccine
TIP: It's not recommended that men get a routine prostate-specific antigen (PSA) test. The PSA test can be falsely positive in many men, which leads to unnecessary further tests and anxiety, says Dubey. Speak to your doctor about whether the PSA test is right
65 and Up
Added to the cumulative list is:
• A one-time bone mineral density test at age 65 – sooner if there are risk factors – and thereafter when the doctor thinks it necessary. (Daily vitamin D and calcium supplements are recommended to prevent osteoporosis.)
• Pneumococcal vaccine
TIP: Routine rectal exams have not been shown to detect disease earlier, but talk to your physician if you have health concerns or symptoms that you think warrant one.
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Next >>Talking to your guy
Here's what the experts think might work to get your guy to the doctor.
• Warm your partner to the idea of thinking about his health before you suggest he make the leap to visiting a doctor. “Ask, 'What's going on in your life? How is work going? Are you feeling overwhelmed?'" says Dr. David Long, a professor of sociology with The King's University College in Edmonton who specializes in research on fatherhood and men's health.
• Play it straight. "Tell your spouse, 'I'm your wife, I love you, and I want to make sure you take care of your health,'" says Dr. Alan Katz, an associate professor in the departments of family medicine and community health sciences at the University of Manitoba in Winnipeg.
• Appeal to your partner's manhood. "Guys equate health with physical and sexual performance," says John Oliffe, assistant professor in the school of nursing at the University of British Columbia in Vancouver. "Encourage him to understand that regularly visiting a doctor helps him maintain his body in top form."
• Talk to your partner about health-related articles you've come across. "We see a big jump in people coming in to see us after there's public awareness on any issue," says Dr. Azadeh Moaveni, a family physician at the Family Health Centre at Toronto Western Hospital.
• Encourage him to ask the doctor when his last checkup was if he's there anyway with one of the kids (and he shares the same doctor).
• Resist the urge to book that appointment for him yourself. Instead, "put up a sticky note to remind him to do it," says Moaveni.
• Get your guy to understand that the sooner he goes to the doctor, the sooner an issue can be addressed, says Oliffe. "The treatments are easier in early stages of an illness," he says, citing high cholesterol, blood pressure and diabetes as examples. All too often, men adhere to the flawed philosophy of "What I don't know can't hurt me."
• Impress on your partner that he's not alone, that many men associate regular physical exams with an invasive procedure. Also let him know that rectal exams are no longer routinely recommended for all males, says Dr. Vinita Dubey, at Toronto Public Health.
• Reassure your man that female doctors – who outnumber their male counterparts – are quite comfortable doing physicals on men. But if your guy won't relax in the hands of a female doctor, help him find a male doctor, says Moaveni. Ask your doctor or pharmacist about male doctors who are taking new patients, or call the College of Physicians and Surgeons in your province.
• Let your partner know that any information between him and his doctor is confidential – even if you share the same physician.
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