By Manoj Jain
Special to The Washington Post
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.
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 finally read one last week.
A survey done by Harris Interactive for the American Academy of Family Physicians. released in June 2007 (Men's Health Month -- who knew?) showed that 78 percent of all married men who visited a doctor had been influenced to come in by their wives.
I once treated a man with a brain abscess who, after a long hospitalization, was put on continuing high doses of intravenous antibiotics. Even with such a serious medical condition, he failed to manage his own health after his discharge: An alcoholic before his hospitalization, he started drinking again and missed two appointments. Finally, his wife (who was running their family and business single-handedly) came in to see me alone, bringing a pen, a notebook and a list of questions about his condition.
Daniel Kruger, a research fellow at the University of Michigan who has done extensive research on mortality rates, notes that behavior isn't the only factor in men's shorter life span; there are contributing genetic and physiologic differences.
Just as in many other species, he says, human "males are built for competition and females for longevity." Physiologically, the male hormone testosterone builds muscle mass, while the female hormone estrogen boosts the immune system and increases the level of HDL, the "good" cholesterol. But Tom Perls, founder of the New England Centenarian Study at Boston University, estimates that about 30 percent of the male-female disparity in longevity is due to biological differences, and 70 percent to social and cultural factors.
Surely, I said to my wife, there has to be a way to get men to change their life-shortening behaviors. "Yeah, like that's going to happen," she snorted.
I would have called the Office of Men's Health in the Department of Health and Human Services -- but no such office exists. An Office of Women's Health, on the other hand, has been operating since 1991, when it was established to correct an imbalance in research and health care.
As I was watching the football playoffs one recent weekend, my wife stepped into the family room during a commercial break. The ads were about trucks, the new BlackBerry, fast food and Cialis. She observed for a while, then suggested, "Maybe if you want men to be interested in their health, this is where to start."
In fact, the government's Agency for Healthcare Research and Quality is already trying. An ad campaign (http://www.ahrq.gov/realmen) promotes the idea of getting regular checkups and preventive medical care. Using the slogan "Real men wear gowns," it shows middle-aged men in (non-revealing) hospital gowns teaching a child how to ride a bike, attending a teenager's graduation and walking a daughter down the wedding aisle.
I just wish they had run an ad during the Super Bowl.
Manoj Jain is an infectious-disease specialist in Memphis. Comments: firstname.lastname@example.org.