This frustrates his wife, although she admits there isn’t much she can do about it. “He’s a grown man,” she says. “I can’t force him to go.”
She’s nagged him endlessly, but he won’t listen, despite near-constant episodes of vomiting and diarrhea. (The couple requested anonymity for privacy reasons.)
The man is not alone.
Experts say that many men willfully resist getting medical help, even when they are sick or in pain. A Cleveland Clinic survey found that most men would rather do almost anything — including cleaning the bathroom or mowing the lawn — than go to the doctor.
“A lot of men tend to put their health on the back burner, and don’t make it a priority,” says Eric Klein, who conducted the survey and is chairman of the clinic’s Glickman Urological & Kidney Institute. “Men tend to be stubborn about a lot of things, with taking care of their health usually near the top of the list.”
But the reasons go beyond mere stubbornness. They are much more complicated, involving entrenched societal attitudes about masculinity and male behavior — conditioning that starts in childhood — that dictate men always should act tough and never show signs of weakness or dependence, experts say.
“Men are socialized to follow masculinity rules from a very early age,” says Diana Sanchez, associate professor of psychology at Rutgers University, who has studied this phenomenon. “Then they are forced to prove their masculinity on a regular basis, largely to the audience of other men, including the playing field and the boardroom.”
Men pay a serious price for this attitude, especially these days as the novel coronavirus strikes a disproportionate number of men, compared with women, for reasons that are still unknown.
They don’t live as long as women, and they tend to suffer more illness, according to Harvard Medical School, citing information from the Centers for Disease Control and Prevention’s vital statistics report. They get sick at a younger age and develop more chronic illness. They have more heart disease, chronic liver disease, alcoholism, suicide and violence-related death than women. They are more likely than women to develop inguinal hernias, aortic aneurysms, gout, kidney stones, bladder cancer, emphysema, duodenal ulcers and alcoholism.
And while women go to doctors more than men, men 65 and older end up costing the health system more, according to Harvard, probably because they do not go in for preventive screenings and ignore symptoms until they become more serious — and expensive.
A 2000 survey conducted by the Commonwealth Fund, a private foundation that supports research into health-care issues, found that three times as many men as women had failed to see a doctor the previous year and more than half of all men had not had a physical exam or cholesterol test.
Calling the statistics “alarming,” the report stressed that many men ignored their symptoms or put off going to the doctor, even for preventive services. And when they did, they were less than forthcoming with their physicians. The report also said that the uninsured, younger men — those between 18 and 44 — men who live alone, the less educated and Hispanic men were more likely to delay care. Hispanic men were twice as likely as white or African American men to avoid the doctor.
The Cleveland Clinic’s results found that baby-boom men — those born between 1946 and 1964 — were the least likely of the men queried to discuss their health issues with anyone.
“Our surveys have found that baby boomers are especially private about personal matters,” Klein says. “Only a third of baby boomers — 29 percent — have more than one person they feel comfortable discussing private health topics with, compared to 47 percent of Millennials [those born between 1980 and 1994] and 44 percent of Gen X [Those born between 1965 and 1980]. A third — 26 percent — of baby boomers don’t discuss private topics with anyone.”
Moreover, “many young men think they are invincible or untouchable, so often times initiating a relationship with a primary care doc is not top of mind for them,” Klein says.
The online survey, conducted among 1,174 American men 18 and older, found that 72 percent would rather do household chores than see a doctor, while 77 percent said they preferred to go shopping with their wives or partners over a trip to the doctor. Only half said they consider an annual checkup a regular part of their self-care.
Additional research conducted by Sanchez and her colleagues at Rutgers confirmed that men holding traditional beliefs about masculinity were the most reluctant to see doctors.
Moreover, when they did go, they were more likely to choose a male doctor over a female doctor — believing men to be more competent — but less likely to be as open with a male doctor, their studies found. They tended to be more forthcoming with female physicians, probably because they believed they did not lose status by being vulnerable with a woman, according to the research.
“Basing self-esteem on self-sufficiency and bravery translates into minimizing health problems and failing to engage in preventive care, or in delaying care,” Sanchez says.
Sanchez became interested in the topic after a personal family tragedy.
In 1997, her 53-year-old father refused medical help after losing partial feeling in his face. “What he didn’t know then was that he would experience a debilitating stroke 24 hours later that would leave him with serious neurological deficits and partial paralysis,” she says. “He was never the same, and ultimately died a year later.”
The experience left her puzzled and searching for explanations.
“His reluctance to act was perplexing, and the consequences of this decision were devastating, so I have always wanted to understand the factors that lead to health-care avoidance and delays,” she says. “I have always wondered why he resisted the pleas of family members who tried to persuade him to go to the doctor when his symptoms first emerged.”
Eric Schneider, senior vice president for policy and research at the Commonwealth Fund and a former primary care physician, says the behavior is quite common. Schneider says he has seen it countless times during his 25 years in medicine. He even admits he’s guilty of it himself — and that it took a significant health scare to prompt him to change. “I didn’t go to the doctor for years,” he says.
But then, more than a year ago, he developed a persistent and worsening case of bronchitis that later turned into life-threatening pneumonia. Initially, “I figured I knew what was going on, and I ignored pleas to go in and get seen,” he recalls. “I had something fairly serious by the time I got in there. So I understand that family pressure for people to come in when they are otherwise reluctant. I personally lived it.”
In his own practice, “it was not unusual for a couple to come in, and the man came in only because his wife insisted,” he says. “And while they were there, the wife would say to her husband, ‘You didn’t tell him this,’ ” suggesting he was reluctant or embarrassed to share everything. “Going to the doctor, for them, was a statement of vulnerability,” he says. “It was always more challenging to build a trusting relationship with a male patient.”
Changing these attitudes may take a long time, but it’s not impossible, experts say.
“First, let’s help boys identify and experience their emotions in ways that are helpful to them, and to their relationships,” says Abigail K. Mansfield Marcaccio, a psychologist in the Men’s Health Center at the Miriam Hospital in Providence, R.I.
“Increasingly, schools are recognizing the importance of social and emotional development, and are including curricula that help students identify and respond to emotions in ways that are helpful and healthy,” she says.
“Second, it’s helpful to launch public health campaigns that encourage help-seeking, and de-stigmatize it,” she adds. “Finally, once men reach out and ask for help, we need to help them be comfortable with their choice. Therapists and doctors who welcome, validate and normalize expressions of pain or distress can make a huge difference.”
People joke that the man who avoids going to the doctor is a lot like the stereotypical male who won’t ask directions when he gets lost. But they are not the same, Sanchez says. And it’s no joke.
“Both behaviors come from a need to be seen as self-sufficient,” she says. “But there is one critical difference. The worst that could happen from not asking for directions is that you never reach your destination. Refusing to go to the doctor, on the other hand, could cost you your life.”