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Men's Health

Big Boys Don’t Cry: Why Men Often Neglect Healthcare

Skye Sturgeon, DAOM |

Most healthcare practitioners in the US report that most of their patients are women. Yet, men are more likely than women to suffer from major health conditions, contributing to a life expectancy of more than five years shorter than that of women. Numerous studies conducted world-wide indicate that men avoid seeking healthcare and are 33% less likely than women to visit a doctor for advice and treatment that would benefit their health. According to the Cleveland Clinic, 65 percent of respondents to a survey said they avoid going to the doctor as long as possible and 37 percent said they had withheld information from their doctors in the past, specifically because they weren’t ready to deal with the potential diagnosis that might result if they told the truth. Studies consistently show that men are less likely than women to get preventive screenings, seek timely medical care, or receive recommended immunizations, all of which contribute to poorer long term health outcomes.

stressed out man

Nearly every man that I interviewed while researching this article revealed that the first time they saw a doctor, other than Doctor Mom as a child, was for a traumatic injury, usually while playing sports.  Otherwise, they only sought medical help late in middle age when they experienced somewhat serious problems. Women on the other hand, usually begin their relationship with doctors at the onset of puberty and this connection to self-care continues throughout their lives. Additionally, women’s communication with friends and family is often characterized by openness and collaboration, in contrast with men who are often bereft of this experience and habit.

Why is this the case and what can be done to reverse this situation? There are several key reasons why many men are reluctant to seek medical advice, including psychological, societal, and practical barriers. In some ways, these reasons are related to the traditional norms and values of masculinity that are inculcated into men from an early age. Some of these reasons are stereotypes or clichés, however, their commonality is undeniable since many are unconsciously incorporated into how a heterosexual person identifies as being a man. Of course, the applicability of these factors will vary with individuals, but may help to understand male patients and to inform practitioners how to encourage men to take a more active role in their health.

Traditional Norms of Masculinity

Although associated with biological sex and attributed to the actions of testosterone, masculinity is primarily a social construct that has been developed over time and influenced by culture, religion, philosophy, and family roles and values. Historically and cross-culturally, masculinity is characterized by physical dominance, aggression, self-sufficiency, and emotional stoicism. There are rules that are taught to boys and reinforced throughout men’s lives. In my own life, I can recall being told as a six-year-old at my father’s funeral, “Big boys don’t cry. You are the man of the house now. You need to take care of your mother.”

When injured, boys are exhorted to “Shake it off and get back into the game,” “You need to suck it up!” “Who’s in charge of your emotions right now, son?”  Women are usually allowed to be feminine, but men are often negatively viewed when described as ‘effeminate'. 'Real men’ are taught to support their families, be protective, strong, competitive, dominant, and project power over themselves and others. This is continually reinforced by role models from their family and friends, movies and television, popular culture, and on social media including Reddit forums, ‘bro' podcasts, and the ‘manosphere’.

The cultural / societal ideal of manhood includes authenticity, emotional intelligence, personal integrity, chivalry, courteousness, propriety, good manners, honor, and respect towards others. When pursued in excess, masculinity can become toxic and this may manifest as bullying and extreme aggression, hypervirility that disregards consequences or responsibility, machismo, an inability to accept vulnerability, and even the validation and exercise of violence and abuse. One should understand that most men engage with these norms in various ways and to differing degrees.

Self-reliance and independence

Men avoid engaging with medical practitioners because the norm fosters a sense of I can (and must) take care of everything in my life myself. Asking for help can make a man feel that he is inadequate, as a man. Many men will only consult a medical professional if there’s truly no other option and even then, they may keep things to themselves, thinking they can figure out what to do on their own. “I’m fine. I’ve made it this far in my life, haven’t I?” Largely because of lack of positive interactive experience, many men do not trust doctors to know how to help them. Nearly one half of men report a negative experience with the healthcare they have received in the past.

Toughness and not appearing weak

Some men think that having to consult with a medical professional is a sign of weakness. They minimize pain levels and do not disclose symptoms of illness or impairment to medical professionals Having a need for a doctor can be embarrassing, even more so if it is a mental health practitioner, since men often stuff their feelings and cultivate stoicism. Besides, most symptoms go away on their own if one just gives it enough time.

Time and financial considerations

Many men do not have health insurance coverage and in any case, healthcare in the United States is incredibly expensive. Studies suggest that around one half of men do not have a primary care physician and do not know how to navigate the medical system. Even with health insurance, there are deductibles, coinsurance, and copayments, and many practitioners of integrated or complementary medicine require fee-for-service or out of pocket payments.  Generally, men often avoid incurring expenses that they consider unnecessary or of dubious value and are also reluctant to take time off from work to see medical or mental health professionals, especially if they are self-employed or do not enjoy paid time off benefits from their employer. Those juggling multiple jobs and family responsibilities do not think they have time for self-care, including getting adequate rest and exercise.

Fear

Some studies suggest that the number one reason men avoid the doctor is fear. They worry about a bad diagnosis or outcome and do not want to contemplate the consequences of such a diagnosis, including physical, financial, and psychological. It is almost as if their ignorance is some kind of shield from bad news. “What I don’t know can’t hurt me.”

Practical strategies to overcome men’s reluctance to seek healthcare

Making societal level changes is enormously difficult, and combating men’s identifying markers and norms may seem hopeless. However, men do prefer to be in good health and treating them with respect as individual people can help foster change in health outcomes.

Basic practice building that focuses on men’s health is worth the effort. If you want to see more men in your practice, create marketing materials that target men’s health. It is a bit of a cliché, but in my experience, the most common complaint that cause men to seek an acupuncturist is low back pain. Attend groups, clubs, and businesses in your community that attract men and give a talk or leave a flyer that speaks directly to men and low back pain. Think of fraternal and service organizations, golf clubs, barber shops, home improvement stores, pubs, and bars, etc. When I was able to help a man with low back pain in my clinic, he then was willing to ask about erectile dysfunction, nocturnal urination, fatigue, insomnia, stress, and other health concerns that he had not previously disclosed. Low back pain can be a door opener.

Early on in my practice, I treated many women for infertility. Since the problem frequently involves a dysfunction with the male partner in a heterosexual couple, I insisted that my female patient bring in her partner for a consultation. Often, this led to the man seeking guidance and treatment for other issues they were having, and I offered a discount for couples seeking treatment from me. Although I found that the best engagement with my male patients occurred when the man made the appointment, I encouraged the female to make an appointment for her partner. When both members of a couple are engaged in this way, lifestyle and dietary recommendations are easier to implement, and the long-term health of both is enhanced.

When seeing a male patient, I never try to change their mindset with reason, argument, fear, or shame. Providing non-judgmental and non-adversarial advice is key. I always attempt to treat my patients ‘where they are’ rather than where I think they ought to be. Active listening and empathy will go a long way to engender trust and willingness to engage in health improvements. In my experience, I recommend asking a man what he thinks (rather than what he ‘feels’) he must do, and you will get better compliance and engagement. Providing options allows him to choose what he is willing to do.

To overcome time and financial constraints that often are cited by men who avoid seeing a medical professional, I suggest having office hours in the evening at least once a week. I also found that offering a free initial consultation and discounts for continuing treatment to interest many men. Certainly, a sliding scale, if legal in your state, can be helpful in lowering the barrier to care for some men. For some, a telehealth visit removes some of the barriers that are encountered by an in-person visit to a doctor.

Chinese medicine offers unique opportunities

One of the strengths of Chinese medicine, besides offering unique and extraordinary treatment options, is the emphasis on integral health. Chinese medicine’s focus on harmony and balance in one’s life by promoting common sense, lifestyle choices including dietary recommendations, exercises, adequate rest, and stress reduction is a kinder and gentler approach to healthcare. Interestingly, this low-tech approach may be more in accord with men’s sensibilities, rather than biomedicine with its scary sounding disease names, drugs, and interventions.

In conclusion

Although there are indications that Millennials and Generation Z males may be developing a new definition of how men relate to society and life, generally, the older generations of men require healthcare more urgently. This makes it important that we work to better understand the root causes of this problem and that if we collaborate with men as individuals rather than stereotypes, we may be able to overcome the challenges and help improve men’s health and promote longevity for those we love.

References

About the Author

Skye Sturgeon, DAOM is the Quality Assurance Manager and Special Consultant for Mayway, USA. Skye was the former Chair of Acupuncture & East Asian Medicine and core faculty member at Bastyr University, core faculty member and Faculty Council Chair at the American College of Traditional Chinese Medicine, and President and Senior Professor of the Acupuncture & Integrative Medicine College, Berkeley. Before making Chinese medicine his career choice, Skye held various positions in the Natural Foods Industry for 12 years and prior to that was a clinical biochemist and toxicologist.

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