(Washington Post illustration; iStock)

A few years ago, I found myself in the emergency room. I had hurt my ankle playing basketball, and the pain was unbearable. I remember sitting there, waiting for someone to see me, thinking to myself that it must be broken, or fractured, or something similarly severe.

"I'm going touch your ankle in a few places," the doctor said shortly after I was brought in. "I want you to describe the pain on a scale from 1 to 10."

He pressed down onto various parts of my foot, each one more painful than the last. And yet, the numbers I uttered barely nudged, moving up from 5 to 5.5, and then from 5.5 to 6. I never said anything higher than that.

When the X-rays were in, the doctor showed them to me and told me two things. The first was that I had fractured my ankle. The second was that there was no way the pain was less than an 8. He joked that if I had sought medical care somewhere else, somewhere less precautionary in its practices, I might have been sent away with a prescription for a mild painkiller and a bag of ice.

Machismo, the driver of so many questionable decisions made by men, is a fickle thing. Sometimes, a little bit of it — a tinge of toughness — doesn't seem to hurt. In sport, for instance. Or maybe negotiation. Other times, it turns out, it can do more harm than good. Like, say, when it comes to caring for one's health.

"Everyone has a story about how a male friend or family member has been reluctant to go to the doctor," said Diana Sanchez, who teaches psychology at Rutgers University. "But it's more than that — it's also what happens when they actually go see a doctor."

"There are all sorts of adverse consequences associated with masculinity," she added.

A downside to being too much of a dude

Sanchez first became interested in the subject both because of the discrepancy in the life expectancy for men and women (men tend to die about five years earlier than women) and because of a personal experience with a family member who waited too long to see a doctor. She wondered whether the two might somehow be related. And she figured that there must be a way to find out.

Eventually, she, along with Mary S. Himmelstein, a doctoral candidate at Rutgers, devised two studies to explore the extent to which masculinity affects decisions about health care. And together they suggest that the effect could be fairly significant.

In the first of the two studies, which was published in the Journal of Health Psychology in late 2014, they gathered two groups — one of them comprising university students, the other not. They measured the importance of manliness to the individuals in each group, using a scale called the Contingencies of Self-Worth (CSW for short), which was developed by researchers at Ohio State University. (The process involves questions that force the participants to rate the significance of bravery and self-reliance to their respective genders as well as to them personally). They also asked questions about health care, including ones that gauged the frequency with which the participants sought out preventive care and the regularity with which they delayed care.

What they found is that for both men and women, those who exhibited the most machismo (deriving self-worth from things such as bravery and self-reliance) were also the least likely to seek preventive care and the most likely to delay care.

"Masculine men, in particular, tend to avoid the doctor," Sanchez said. "Obviously, that's not a good thing."

In the second study, which was published in the journal Preventive Medicine in December, the researchers used three experiments to approximate what happens when people actually end up going to the doctor.

In the first two, the researchers tested the relationship between masculinity and male doctor preference, measuring each in the roughly 150 participants (all male) and finding that the two exhibited a strong correlation.

In the third, they explored what happens when men see male doctors. They had 246 individuals (all male) complete a prescreening, during which the researchers also measured masculinity, and then had them come in and discuss their ailments with either male or female medical students (all of whom were unaware of each patient's masculinity score).

The results were fairly straightforward. Per the study:

In accordance with predictions, men with higher scores in masculinity reported fewer symptoms in the lab compared to their prescreen reports when reporting to a male interviewer relative to a female interviewer.

This chart, plucked from the study, does a good job of showing the results, too:


Men, in short, are less likely to seek preventive care than women and more likely to put off seeing a doctor when in need of medical care. They also prefer to seek out male doctors, but they tend to underreport pain and injuries to male doctors, thereby compromising the chances of receiving optimal care. And all of this, it should be said, is particularly true among those men who prescribe to masculine ideologies.

"Masculine men tend to not go to the doctor, and when they do, they tend to pick male doctors whom they then underreport their ailments to," Sanchez said.

A dangerous game

There is some humor in Sanchez' research. It's because of their own foolishness, after all, that some men — those who swear by archaic, rigid, animalistic understandings of their own sex — could be compromising their health. The cycle the two successive studies suggest certainly paints such a picture.

But there is also, hopefully, some humility to be had. The consequences of delaying care when experiencing health issues is no joke. Nor are those that might arise from communicating poorly (or, really, inadequately) with your doctor.

"I think these findings will really resonate with a lot of people," Sanchez said. "But I also think people should take this seriously. This is something doctors should be aware of."

I spoke with three doctors, all of whom acknowledged that what Sanchez has found makes sense. They said that it's well known and problematic that men are less likely to seek preventive care than women. They agreed, based on their experience, that men, generally speaking, tended to approach visits to the doctor differently than women.

"All of this seems plausible," said Peter Hoenig, a doctor who has worked as a generalist in Massachusetts for more than 30 years.

But he also cautioned, as did others, against brandishing too wide a brushstroke. The complexities of individuals, they noted, seemed to far outweigh the quirks of gender ideology.

"Be careful of putting too much weight on machismo," Hoenig said. "It is pretty light clothing and sheds easily."

"For several years, I worked as an emergency physician in a worn-out industrial city," he added. "It was not uncommon for a 300-pound-heavy, tattooed motorcycle guy to faint at the sight of a needle and a little old lady with pink pajamas to endure minor surgery without anesthesia in order to get home quickly to be with her poodle."

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