Men may avoid preventive health measures

It seems that women tend to be proactive about their health, whereas men tend to be con-active. They think about why everything's going to be fine (because they've been fine, and will likely continue to be fine) and that whatever symptoms they're having are nothing to be worried about. Men realize they aren't immortal, but given that a certain rugged chivalric independence is the implicit cultural goal, every new diagnosis, every new medication is a wounding, a diminishment, a reminder that they're not as strong and vital a person as they used to be.

This con-active approach often leaves men less medically informed. We all have male friends who have a voluminous and encyclopedic knowledge of their fantasy football or baseball teams. But if you ask them what their risk factors for cardiovascular disease might be, they don't know. If you ask them what a PSA is, they might guess “public service announcement” or “some type of pilsner?” instead of a prostate-specific antigen test.

I have found that men respond to the parallels between good financial planning and good health care. In finance, the goal is to start saving money early. If you finally get your financial stuff together at age 63, well, better late than never! But you know what? It would have been better if you started investing at 53, 43, or even 23, because the investments you began in those early years are going to pay off big as you get older. Similarly, if somebody shows up in the office at age 52 saying, “I'm here because my dad had his first heart attack at 53,” of course we're delighted to see him, but it would have been better if he'd made an appointment 10 years earlier. Addressing health risk factors early on is the health equivalent of compound interest.

That tendency toward a con-active, minimalist approach to health means that men can be more easily overwhelmed by the complexity of their medical care, which is one reason it makes sense to focus on the big things. For example, I'll ask my male patients, “You're 63. What are the two most likely things that are going to cause you to die early?” And those are cancer and cardiovascular disease.

I'll explain prostate cancer screening, and the fact that although prostate cancer is by far the most commonly diagnosed cancer in men, lung cancer remains the deadliest, well in front of prostate and then colon cancer. When it comes to cardiovascular disease, I review what the main risk factors are and discuss how we can measure/test for those factors in order to calculate what their specific overall risk is, and, based on that risk, what or what not to do about it.

I find the calming effect of simplicity and clarity extends to the way in which we prescribe medications to our patients. We get people in the hospital who have a surprise diagnosis of, let's say, cardiovascular disease. Before the event, they were pretty active, and either unaware of or uninspired by their risk factors, and so they are in a bit of shock over their sudden and serious diagnosis.

Then we start them on goal-directed medical therapy (GDMT), and they walk out with what seems like a shopping bag full of medications. When they are at home and feeling better, they wonder why they need all these pills if “like they said, that angiogram got rid of the blockages.” Feeling frustrated, overwhelmed, skeptical, or suddenly cash-strapped, they stop taking some or all of their medications.

So, for all patients, and particularly for men, I wish we could roll out GDMT (and other complex treatment regimens) in a more measured, easy-to-swallow way. I'd like to say, “We have a regimen of medications that we think can really help you and make this the last time you're in the hospital for your heart condition. We want to start a couple of them. And if you tolerate those, we'll see you a month from now. If those are working well for you, and you're feeling good, we'll talk about adding another drug or two that could help you.”