Tailoring care for men

Seven million American men have not visited a doctor in a decade. It's easy to imagine the comforting notions that contribute to this statistic.

If you don't ask for it, you won't hear bad news. If you feel fine, why ask for trouble? If nothing is broken, don't worry about fixing it.

Often enough, however, something is broken -- and that's the case even if the patient can't recognize the symptoms or would be happier in denial.

It is well documented that men as patients often demonstrate a general avoidance of their primary care physicians. Some physicians, researchers and public health policy experts argue that the disparity in health outcomes between men and women could be linked to the differences in how the sexes interact with the health care system.

Consider the numbers. Life expectancy for men is roughly five years less than that for women -- 74.7 years compared with 79.9 years. This gender gap becomes even greater when racial and ethnic differences are factored in. Black men, for instance, die about 12 years before white women. Additionally, 40% of black men and 37% of Latino men die prematurely, often from strokes. This number is set at 21% for white men.

Overall, men have a higher age-adjusted death rate than women for the 15 leading causes of death in the United States, with the exception of Alzheimer's disease. And death rates attributed to some of these top mortality-causing illnesses are frequently attributed to a lack of regular screening and preventive health care. That's where the trouble with men's health care avoidance becomes evident.

Because men often don't go to a doctor even annually, they risk missing the important screening examinations.

Women, on the other hand, seem more connected to their medical homes because of contraceptive needs and the well-ingrained annual Pap smear ritual.

The situation contains a comparison that has led some experts to contemplate how to help men take better care of themselves.

To this end, the AMA has policy promoting the idea that health care for men differs in many ways from health care for women. The Association also encourages research and medical education to address the reasons that men have shorter life spans, to develop ways to engage men in their health care and to develop methods to improve access to care.

Meanwhile, some physicians are talking about the creation of a specialty in men's health. Also in recent years, legislation has been introduced in the U.S. House of Representatives to establish an office of men's health within the Dept. of Health and Human Services.

What the future holds for such proposals is not clear. But increasingly important is the fact that women and men make for very different patients, requiring very different approaches.

It's more than just physiology -- it's mindset.

Male patients are generally less likely to give personal information -- even to their doctors -- and need to be asked directly about sensitive issues. They are usually most likely to have a medical home if the women in their life push them toward it. And now, some physicians say that pharmaceutical products such as Viagra might offer an " in" that brings these patients to an initial exam and leads to opportunities to discuss other health issues.

Responsibility, of course, ultimately falls with the patient. But it is critical that physicians be aware of the subtleties involved.

And many male physicians need to be reminded that they, too, sometimes have to be patients and should have regular contact with a doctor of their own.

Success in appropriately tailoring treatment with gender in mind would be a boon to improved preventive health for all patients.