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Thursday LOVELAND REPORTER-HERALD/Health Line of Northern Colorado June 18, 2009
The doctor is in
Real men ought to know when to speak with a doctor Manoj Jain The Washington Post
“Did you know that women live longer than men?” I asked my wife. Of course she did — and not just because, like me, she is a physician. Anybody who walks into a nursing home can see the imbalance. Most people’s grandmothers outlive their grandfathers, and 85 percent of centenarians are women. So my wife nodded, without paying much attention. “It isn’t really that women are living longer, but men are dying sooner,” I persisted. “Among the top 10 causes of death, men have a higher mortality rate than women. Men are four times more likely than women to suffer from cirrhosis of the liver and alcoholism.” My voice rose a bit dramatically. “Men are dying, and no one is paying attention.” “I never thought of it that way,” she said, with a small note of sympathy. But then she caught herself: “You do this to yourselves.” She had a point. Eighty percent of Americans who have a serious drug addiction are men; more than 80 percent of drunk drivers are men; during young adulthood, the peak age for homicide, suicide and accidental death, three men die for every woman. “It’s your behavior,” my wife said. That led me to wonder: Are there other, less obviously self-destructive kinds of behavior that contribute to my sex’s early mortality? The next morning at hospital rounds, I decided to observe my cases not just as patients, but as male patients or female patients. First on my list was a former salesman in his 50s with a double chin, divorced and living with his daughter, with kidney disease that had put him on thrice-weekly dialysis. As I questioned him about an infection in his line, his eyes remained fixed on the flickering but muted television, his responses were brief and he appeared annoyed by the entire process. I did my exam, washed my hands and asked if he had any questions. “Nope.” And our encounter was complete. My next patient was a middle-aged woman who had pneumonia, according to the emergency room note on her chart. When I began asking questions, she narrated a list of symptoms and elaborated on how she had had nasal congestion for several weeks before she became critically ill. I suspected sinusitis. This was confirmed by a CT scan, and I prescribed antibiotics appropriately. When I asked if she had any questions, she had a list: What caused this? Could she have avoided it?
Would it resolve completely? When could she go home? Had she been more inhibited in her conversation, I would not have uncovered the underlying cause of her pneumonia so quickly. And once she leaves the hospital, her willingness to demand information means it’s likely she will manage her health better. Did I fail to get significant information from the conversation with my male patient? Almost certainly. Did he lose an opportunity to gain insight into his illness? Yes. It was a pointed illustration of the sex difference in healthcare behavior. Women visit the doctor more often than men, and nearly twice as often for preventive care, according to a 2001 study by the Centers for Disease Control and Prevention. Among 45 to 64 year olds, women spend 50 percent more on healthcare than men (an average of $2,871 a year vs. $1,849). In my experience, doctors spend more time per visit with women than with men, as I certainly had done with my female patient that morning. Later in the day, I asked Belinda, an intensive care nurse with more than 25 years of experience, if she noticed differences between men and women as patients. “Most certainly,” she said, and gave me an example from her own life. She and her husband, Bob, had gone to the same doctor for routine physicals. The office nurse put them in separate exam rooms with the doors cracked open. The doctor visited Bob first and began by asking if there were any problems. “Nope,” Bob said. “That is absolutely not true,” Belinda shouted from next door. “Bob, you tell the doctor about your sinuses. And the blood pressure and your back.” The doctor invited Belinda to join them. In my practice, I often do the same. I look to the spouse to give a more accurate history of illness, especially when the spouse is female. “This is because women are natural nurturers and caregivers.” Belinda told me. I was mildly offended. But I have to admit that around my house, our kids, our friends and extended family, including my own parents, give more weight to my wife’s medical opinion than to mine. This is true even on matters of infectious disease — my specialty. Women are also known to be greater consumers of health information. I’m certain more women than men are reading this page. A physician colleague tells me that his wife reads my health columns religiously and for years has encouraged him to do the same; he final-
ly read one last week. I once treated a man a long hospitalization, es of intravenous antib medical condition, he after his discharge: An tion, he started drinkin pointments. Finally, hi bringing a pen, a note about his condition. Daniel Kruger, a res Michigan who has don ty rates, notes that beh men’s shorter life span and physiologic differe Just as in many othe are built for competitio Physiologically, the m muscle mass, while th boosts the immune sy HDL, the “good” chole the New England Cen sity, estimates that abo disparity in longevity i