Where are the Men?

First, the facts: Adults tend to find reasons to justify not going to their doctor. For men, it’s a larger problem than for women. Harris Interactive conducted a survey for the American Academy of Family Physicians with 1,100 men where 58% of them said that even under the best of circumstances, something still keeps them from routinely seeing their doctor.

Why are they so reluctant? Here is how they responded in the Harris survey when asked their reasoning:

  • I only go to the doctor if I am extremely sick: 36%
  • I am healthy; I have no reason to go to the doctor: 23%
  • I prefer to treat myself naturally: 12%
  • I don’t have time to go the doctor: 12%
  • I don’t have health insurance: 11%
  • I don’t like doctors: 8%
  • I am afraid of finding out something is wrong with me: 7%
  • I don’t know of a good doctor in my area: 4%
  • Nothing really prevents me from going to the doctor: 39%

Most of the men in the survey also reported having health insurance and a family physician they could go see.

Furthermore, a study on “macho men” and the influence of socioeconomic status shows that men with strong masculinity beliefs are half as likely as men with more moderate masculinity beliefs to receive preventive care.

And in contrast to the well-established socioeconomic status gradient in health, men with strong masculinity beliefs do not benefit from higher education and their probability of obtaining preventive health care decreases as their occupational status, wealth, and/or income increases.

Authors concluded that masculinity might be a partial explanation for the paradox of men’s lower life expectancy, despite their higher socioeconomic status1.

Seeing the forest from the trees

So, what does the big picture have to do with vein care? Simple… It’s common in a vein clinic to see women at all stages of venous disease. On the contrary, it’s uncommon to see men with early stages of venous disease – rather, it’s more likely that male patients have more advanced chronic venous insufficiency.

When you pause from the daily patient list and look broadly at patient demographics, it’s very much like seeing the forest from the trees. In our clinics, it’s common to see men with large varices and multivessel superficial reflux or >C4 disease who minimize their symptoms or claim to be asymptomatic. Often, they are dragged by their spouse, partner or family member into the office. It could be that men may be reluctant to undergo procedures, so offering options – including conservative therapy – becomes the typical recommendation but often with a suboptimal longterm outcome, especially from their spouse’s perspective.

In our office, more than 75% of patients are women and the average age for women across our network is 55 years old. For men, the average age is 63 years old. This corresponds with the national trend in men’s health where men often delay treatment and avoid preventative care until there is a more significant problem.

The key to connecting with men is understanding why they don’t seek care in the first place and learning to speak their language. Our experience has revealed that, quite simply, men don’t seek relief from venous disease due to lack of time and/or waiting until symptoms flair or create disruptive complications.

Here are some tips that we employ to bring more male patients to our vein practice:

Education-Information – Educating your community is important for a number of reasons, but men will be more likely to seek care if they know venous disease is common, treatable and covered by most insurance (meaning, affordable). They may be more hesitant if they think they have an unusual disease that is difficult to treat, has bad outcomes or is expensive out of pocket.

Get their spouse on your side – Spouses, significant others and/or close family members are people of influence in men’s lives. They hold a power and influence that others do not. Therefore, it’s important to break through the tough shell a male patient may present and connect with his support network. Appropriate guidance will help alleviate fear and preconceived notions about what vein care is all about. Often when my patients come in together as a pair, it helps make the process easier and future visits become more comfortable.

Make a deal for compliance – If your patient wishes to have procedures done, make sure to be compliant if there is a health insurance “stocking use” requirement, but don’t hold their feet over the fire and force them to wear compression stockings all the time. If they prefer a beer and a hammock to compression stockings, it’s OK to give a little; their feet are still up if they are resting in a hammock! Or, consider advising athletic compression stockings rather than traditional stockings. Standing in a swimming pool is another alternative and a great option. Remember, your goal as their doctor is to find a good long-term solution for the patient’s vein-related pain. Compliance is key.

Make it pleasant – The more unpleasant an experience, the less likely someone will repeat it. Make sure all patients are treated with dignity and respect, with clear communication regarding outcomes. Knowing you are doing your best for their best outcome, it’s likely your patients will be proud of the results, feel like they have “won the battle against their veins” and will refer their male friends to you.

Use a sports injury as excuse – Often, men will seek care for a sports-related injury when they wouldn’t seek care for venous disease or preventative care. You can use this to your advantage as a phlebologist by talking with orthopedic surgeons, physical therapists, and physical medicine and rehabilitation physicians (PM&R). They commonly see patients’ legs and can refer the appropriate patients to you. A bird in the hand is worth two in the bush.

Use your friends – Make sure your medical/physician/ provider friends know what you do and know the impact on patient care that you can deliver. Once a person whom the patient trusts recommends you, the easier it is to endear your trust unto the patient.

Make it convenient – Offering a flexible clinic schedule with late and weekend hours is a great way to make it easier for patients to see you. Breaking down the barrier of the need to take time off work to see a physician is a great catalyst for securing a new patient appointment. This works for both men and women.

Referrals are a two way street – Smoking cessation, hypertension, lifestyle risk factors, mental health issues, sexual health issues and heart disease are all important issues for which a male patient may be reluctant to seek care. If you identify a non-vein related problem in your patient, make sure to refer them appropriately to their existing PCP or another provider. This elevates the likelihood that you will receive reciprocal referrals.

Reference:
1. “Macho Men” and Preventive Health Care: Implications for Older Men in Different Social Classes. K Springer, D Mouzon. Journal of Health and Social Behavior, June 2011; vol. 52, 2: pp. 212-227.


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