Being a Patient
Want to Live a Bit Longer? Speak Up.
Tuesday, February 17, 2009
"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 health-care 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 health care 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.