July 6, 2021 -- When Armin Brott began having tingling and tremors in his hands, he wasn’t very concerned. After decades of practicing full-contact martial arts, he knew how to live with discomfort. It was nothing that Advil and some stretching couldn’t fix -- or so he thought.
His symptoms worsened, eventually becoming unbearable. After he saw a doctor, an X-ray and MRI showed that he had severe spinal compression and needed emergency neck surgery.
“My response is typical of many men who don’t go to the doctor, even when they have serious symptoms, or take good care of their health,” Brott, who is the senior editor of the Talking About Men’s Health blog and a member of the board of advisers of the Men’s Health Network, tells WebMD.
This was the case, even though I’ve been writing about and researching men’s health for decades and one might think I ‘should’ know better,” Brott says.
But the same behaviors and approaches that affect other men affected him as well.
These male patterns of seeking -- or not seeking -- help for medical problems were apparent in a study done by the insurance company Aflac in April 2021 and published in June in conjunction with Men’s Health Month.
The study surveyed 1,000 U.S. men ages 18 years and above and found that, in the past year, almost half (45%) had not visited a family doctor or general practitioner for an annual wellness visit or checkup.
Even more concerning, three-quarters had not gone to the doctor even if they had symptoms of a specific illness, 84% had not consulted a doctor about an injury, and over half (54%) had not gone to a dentist for a routine dental exam.
Sterling Ransone Jr., MD, a family doctor in in Deltaville, VA, tells WebMD that the findings reflect what he has seen in his own clinical experience.
“I’ve had the general impression that I see more women in my practice in the course of a day, compared to men, but I never actually sat down and quantitated it. After reading the survey, I did and saw that only approximately 30% of my patients are men,” he says.
Brott, who is the author of several books about men’s health and parenting, including Blueprint for Men’s Health, agrees.
"This survey reflects data that have been around for a long time, showing men’s disproportionately low use of health care."
Jeramy Tipton, a senior vice president at Aflac, tells WebMD that the company wanted to “bring attention to issues affecting men, awareness of health issues, motivations for men to seek medical attention, and barriers to doing so.”
The survey findings were striking in the “major disconnect” between the perception of respondents and the actual lifestyles they lead,” he says.
Although 90% reported they lead a “somewhat” or “very” healthy lifestyle, the reality is that close to half have had not seen a doctor for the past 12 months and only one-third agreed that they felt “well-informed” of the various illnesses and ailments that commonly affect men, Tipton notes.
Part of the reason for the survey was to shine a spotlight on men’s “lack of awareness and education” about their health, including the importance of early detection of some major illnesses.
A small number of survey participants (6%) acknowledged that going to the doctor make them “feel less masculine.”
Will Courtenay, PhD, a California-based psychotherapist and author of Dying to Be Men, a book for medical and mental health professionals about counseling men and boys, suggests there is a belief held by many men: “I’m a real man because I don’t need a doctor.” Men who believe this may think that needing help means admitting defeat.
Ransone, who is the president-elect of the American Academy of Family Physicians (AAFP), agrees.
“You may be told that you have hypertension or diabetes and need help controlling your blood pressure or blood sugar, and some men see help-seeking as a failure and are embarrassed,” he says.
But where do these ideas come from? According to Brott, these messages are taught to boys at a very early age.
“It starts with ‘big boys don’t cry,’ and -- as the boy gets older and perhaps joins a sports team -- the message is to ‘man up’ or ‘take one for the team.’ Eventually, these external messages become internalized,” Brott says.
But the problem goes beyond the perspective that seeking help isn’t a “manly” thing to do, Courtenay notes.
“It has to do with how health care and healthy habits have been feminized in this country, so guys often worry that they’ll be seen as less than a man if they are concerned about their health,” he says.
It also has to do with another message men receive, which is that men don’t talk about what’s going on inside them, according to Ransone.
“Men are socialized not to be communicative about themselves, including their physical health issues, and think, ‘I can push through this on my own.’”
Men’s Health Is a Women’s Issue
Nearly half of the respondents (44%) in the Aflac survey admitted that they were persuaded by their life partner (wife/girlfriend or husband/boyfriend) to visit the doctor. But women, in particular, had the strongest influence, with over half (56%) of men reporting that it was their wife, girlfriend, or mother who motivated them to get medical help.
Ransone, who is an assistant clinical professor of family medicine and population health at Virginia Commonwealth University in Richmond, has seen this in his own practice.
“I can’t think of a single time a male patient talked his female partner into coming into my office with a health concern, but I can think of many men whose female partners convinced them to come,” he says.
Ransone recounted the story of a male patient who came to see him for a checkup. “The examination was fine, and I detected nothing out of the ordinary,” he recalls.
But the patient’s wife called an hour later, sounding worried. It turned out that her husband had been having pain symptoms on and off that he had not shared with Ransone during the appointment.
“I managed to reach the patient, and he admitted that he was embarrassed to bring his concerns up to me. If his wife hadn’t persisted, I never would have known,” he says.
So it is important for women to be proactive and persistent in persuading partners to get medical help, Ransone says.
Brott acknowledges that women already have “plenty to do in their own lives” and that it’s “unfortunate” that another responsibility is being placed upon them. But “men’s health is a women’s issue, and men’s health affects the entire family. If women want the men in their lives to remain alive, they may have to take a more active role.”
Persuade, Don’t Lecture or Nag
A significant number of survey respondents (43%) said they have argued with someone, either family or friends, about going to the doctor, while a third said they have argued with their life partner about it.
Disturbingly, 42% of respondents said they have withheld information about their health from family or friends -- particularly women -- to avoid an argument, which “points to the very important fact that the persuasion must be done skillfully,” Courtenay says.
“There is lots of research on how people change unhealthy behavior. If people aren't ready to change -- and more men than women aren't ready -- pressuring a man will only make him dig in his heels and stubbornly resist” says Courtenay. “The problem is pushing him to take action before he’s ready. So, you just want to help him to start thinking about going to the doctor.”
He recommends that women provide “lots of information and education, since women are a lot smarter than men about health” -- but with an important caveat. The education should be delivered “without pressure, and never, ever preaching or nagging,” he emphasizes.
Ransone says the same approach applies to doctors as well. The Aflac survey found that 14% of respondents admitted they are not completely honest with their doctor about their lifestyle habits (for example, alcohol use, smoking, or exercise), and 12% said they held back information for fear of being lectured.
“We all have patients who are overweight or are smokers, and we have to be careful and sensitive how we address these topics with them because what we -- from a medical standpoint -- perceive as being ‘assistive,’ they might see as ‘lecturing’ and might avoid getting care from us because of it,” Ransone says.
Other barriers reported by respondents were that going to a doctor is inconvenient and it is easier to go to a walk-in urgent care facility or emergency clinic (22%). And about 13% of respondents said they were too busy with work to see the doctor.
The high cost of medical care was another concern, with 45% of respondents saying they postponed or avoided medical treatment in some form due to costs within the past 12 months. This included not pursuing doctor-recommended health screenings and follow-up treatments and/or not filling a prescription medication after a medical consultation for a health problem.
“From a barrier perspective, high medical cost is something we feel we can help with,” Tipton says. “Many of our policies provide benefits for going to the doctor for health screenings, for example.”
He notes that 10% of respondents said they would be motivated to see a doctor if they directly received a cash benefit as part of the insurance claim.
Ransone says that one of the benefits of a relationship with a trusted primary care doctor is that it can help overcome many barriers in help-seeking, often including financial ones.
He recounted the story of a patient with worrisome symptoms who delayed having a medical consultation for 9 months out of concern for the high cost of medical treatment and potentially losing his job if the condition would turn out to be serious. Eventually, the patient’s wife convinced him to come for an appointment, and the condition was indeed serious: He had cancer.
“We all know that medical bills are the number one cause of bankruptcy in the U.S., and people are understandably worried, but our office has a program where we can waive fees for a certain amount of time if a person loses insurance, for example, and we might have been able to be helpful,” Ransone says.
Talking to a trusted provider is a starting point.
Hopefully, you can be pointed toward financial resources, and any treatment you need can begin long before an illness becomes too advanced to treat, Ransone says.
A Reassuring Message
One way to read the survey findings is by focusing on what is positive and encouraging, Courtenay says.
“Let’s remember that over half of the respondents -- 55% -- did visit a family doctor or general practitioner for an annual checkup or wellness visit in the last year, which is actually very good news that we should be talking about as well.”
“One of the problems with the old maxim that ‘men don’t go to the doctor’ is that it becomes a dictum, and men hear that as they shouldn’t go to the doctor, that men don’t do that,” he continues.
In fact, Courtenay’s research suggests that while most men are concerned about their health, they think that most other men aren’t, and the “problem with this misperception is that it discourages men from taking charge of their health.”
So, one way of correcting this misperception is by “accurately educating men about that fact that, increasingly, men are seeking help from medical and mental health professionals,” he says.
Brott adds that, on a policy level, laws should be passed and funded to create an office of men’s health, to “do what the Office of Women’s Health has done for years -- encourage women to get regular breast exams and pap tests, for example.”
This will both educate men about male health concerns and normalize the need for men to pay attention to their health and be proactive in caring for it, Brott says.