Men rarely see Thomas J. Weida, MD, for medical tests without prodding from a wife or girlfriend. When they do show up, Weida jokes that he “can see the drag marks on the carpet.”
It’s amusing, of course. But it can quickly turn serious when a man ignores important symptoms. Weida says he knows of men who got away with ignoring chest pain for a couple of weeks. Eventually, though, they died of heart attacks.
Why won’t men go to the doctor?
Doctors WebMD posed that question to cited a number of possible reasons men avoid doctor visits. Among those reasons were stoicism, high cost, busy schedules, the challenge of getting an appointment, or the embarrassing possibility of the digital rectal exam. Another theory about why men don’t go is that women get more accustomed to visiting doctors than men do. They go to doctors because of pregnancy. And they are more often the parent who takes the children for medical appointments.
Of course, some men might simply be afraid of what a doctor might say. Millions of men are still smoking, eating poorly, drinking too much, or not exercising. They often pay for these bad habits because those habits can have severe consequences for their health.
The question of what to do about men’s reluctance to see a doctor has bedeviled health professionals for decades. Complicating it is the debate within the medical community about whether an annual checkup is really the best way to deal with problems stemming from lifestyle choices.
Surveys show that many doctors and patients still believe in the power of the annual exam. But back in 1995, the U.S. Preventive Services Task Force, an expert panel convened by the Agency for Healthcare Research and Quality, rejected the idea that the standard annual physical exam is an effective tool for improving the health of patients. What the panel did say was that the content and frequency of periodic health exams needed to be “tailored to the age, health risks, and preferences of each patient.”
Also, the task force found little evidence of important benefits from certain routine tests that were regularly included as part of an annual exam. These tests included blood tests for diabetes, thyroid diseases, or anemia; chest x-rays; electrocardiograms; and urine tests. Instead, the panel said doctors and nurses should deliver prevention messages about personal health
Develop a strong relationship with your doctor
Rick Kellerman, MD, is president of the American Academy of Family Physicians. He tells WebMD it’s more important to establish “a medical home” than to have a yearly checkup. By that, he means establishing a relationship with a “physician you know and trust and who knows your medical history.” This physician, he says, can then choose steps for prevention that meet your particular needs.
Kellerman says that patients who establish strong relationships with their doctors are more likely to receive appropriate medication when they need it. They are also less likely to be subjected to needless and costly medical test. Weida adds they’re also more likely to call or make an appointment when they do have a problem.
The most important consideration when choosing a primary care physician, Kellerman says, is how well you communicate with him or her. If you don’t feel comfortable talking to your doctor, choose a new one. Another important consideration is how accessible the doctor is. If you have an acute problem, will the doctor be able to see you that day?
Be on the lookout for specific health conditions
Though an annual checkup may not be required, men do need to be on the lookout for certain conditions as they age. The following list of “musts” and “maybes” distinguishes the medical tests that virtually all men should have from those that depend more on personal and family history.
To create the list, we used recommendations from the evidence-based guidelines of the U.S. Preventive Services Task Force. We also asked for recommendations from physicians consulted by WebMD. Your own doctor may recommend more -- or fewer - tests, depending on your medical history.
Must-have medical tests
The following is a list of tests that every man should have performed routinely:
- Blood Pressure. High blood pressure can cause serious organ damage or death. But screening for it is easy and reliable. The task force recommends screening all adults for high blood pressure, and a blood pressure check is part of most routine doctor’s visits. In some cases, however, the stress of visiting a doctor may cause your blood pressure to go up. James King, MD, a family physician in Tennessee, recommends also getting tested at a drugstore or using a home testing kit to get a more reliable reading.
- Cholesterol. The task force recommends cholesterol screening for all men 35 and up. It also recommends screening for men 20 and up if they have other risk factors for heart disease. Examples might be diabetes or a family history of heart disease or high cholesterol. After that, the task force suggests cholesterol checks every 5 years or more often if your cholesterol is borderline high. How long must this go on? Cholesterol levels are less likely to increase after age 65. So screening may be less necessary after that age.
- Colorectal cancer. Colon cancer kills more than 56,000 people every year. But the CDC says that nearly 60% of those deaths could be prevented if everyone was screened properly and treated appropriately. The task force strongly recommends screening of all men (and women)age 50 and up for colorectal cancer. People at higher risk may need to be screened at a younger age. This includes people who have a close relative who had colorectal polyps or cancer or who have inflammatory bowel disease. There are several techniques for screening. Each has its own set of advantages and disadvantages for individual patients. The ideal interval between screenings depends on the test. But CDC data from 2005 suggest that nearly 42 million Americans over 50 have not yet been screened appropriately. “The best [test] is the one that is done,” Kellerman says.
- Immunizations. Immunity can fade over time, and vaccine recommendations change over the years. For men over 50, a tetanus booster is recommended every 10 years. Flu shots are suggested every year for this age group. And a pneumococcal vaccine is recommended once at age 65.
Maybe medical tests
You may or may not need the following tests. It all depends on your particular situation.
- Prostate Cancer. Prostate cancer screenings are among the most controversial medical tests today. The task force has taken a pass on the issue. It says there is not enough evidence to recommend for or against routine screening with either the prostate specific antigen test (PSA) or digital rectal examination. While the PSA can detect prostate cancer in its early stages, it can also return many false positives. “You could go through surgery and end up incontinent or impotent [as a result of complications from surgery] for something that wasn’t going to cause you any problems,” Kellerman says. He suggests talking to your doctor about the relation between prostate cancer, age, and family history. Then you can decide together whether to take the PSA. The PSA is most likely to benefit men aged 50 to 70. It can also be beneficial if you are over 45 and are at increased risk.
- Diabetes. The task force doesn’t take a stand on the need for routine screening of all adults for type 2 diabetes. But it does recommend diabetes screening for adults who have high blood pressure or cholesterol. Kellerman also screens many of his overweight patients for diabetes.
- Skin cancer. The task force says that benefits from skin cancer screening “are unproven, even in high-risk patients.” But doctors are told to be alert for moles with unusual characteristics while doing exams for other reasons. The American Academy of Dermatologists begs to differ. Academy President Boni E. Elewski, MD, suggests a monthly self-exam to look for irregular moles. She recommends a trip to a dermatologist once a year for a complete skin exam.
- Testicular cancer. Testicular cancer mainly affects young men, ages 20 to 39. Though testicular cancer is rare, it is curable if detected early. The task force finds that “little evidence is available to assess the accuracy, yield, or benefits of screening for testicular cancer.” Nonetheless, the American Cancer Society recommends a testicular exam “as part of a routine cancer-related checkup.” Regular self-exams are not necessary, according to the society.