May 3, 2019

Why are men such 'bad patients'? (And what can hospitals do about it?)

Daily Briefing

    Read Advisory Board's take: 4 reasons your organization may want to target male patients

    Male patients typically avoid the doctor, so hospitals increasingly are creating specialized centers for men's health, using issues that matter most to male patients to get them in the door and treated for other issues they may be ignoring, Laura Landro reports for the Wall Street Journal.

    Why are men such 'bad patients'?

    "Men are notoriously bad patients," Landro writes.

    Research shows that men from a young age are conditioned to avoid showing signs of weakness and sharing their emotions, according to Landro. "Men have connected to ideas of masculinity that say you don't talk to others about your problems, and if there is a problem you fix it yourself," Mieke Thomeer, associate professor of sociology at the University of Alabama at Birmingham, said.

    And that reluctance to admit weakness applies to seeking out medical care for sickness or pain. Research shows 89% of women reporting having at least one health care visit in the past 12 months, compared with just 79.5% of men.

    Among the 59% of men who said they had reasons for not seeking medical care, the research shows that 31% reported only going to the doctor when they're extremely sick and 21% said they were healthy and had no reason to go.

    Men also tend to engage in riskier behavior than women.

    In turn, men have worse health outcomes than women. Men die about five years earlier than women and have higher rates of suicide cancer, diabetes, heart disease, and high blood pressure, according to a Harris Poll/American Academy of Family Physicians (AAFP) survey. Which is not to say women aren't disadvantaged in the health systems in other ways, Landro reports. For instance, women have the double the risk of dying within 30 days of a heart attack than men.

    How urologists became the 'quarterback' of men's health

    While the research shows men often avoid or delay medical appointments, experts say there is one specialist male patients are more inclined to seek out: urologists.

    David Paolone, vice chair of community and regional urology at the University of Wisconsin School of Medicine and Public Health, said, "A guy could go decades without seeing a doctor, but when he is having trouble with erections or waking up three times in the night to urinate, he will seek medical attention."

    As a result, some medical centers are making urologists "the quarterback for broader concerns about men's health urologists often provide comprehensive, male-focused care and look out for symptoms of other health problems. Erectile dysfunction, for instance, has been directly linked to heart disease and can be a symptom of high blood pressure, obesity, diabetes, or depression.

    But urologists are not trained to treat all conditions, so some hospitals are launching male-focused centers where men who come to see their urologist can easily make appointments with other providers as well.

    According to James Kashanian, assistant professor of reproductive medicine at Weill Cornell Medicine, almost 50% of major hospitals have men's health centers, up from about one-third in 2014.

    For example, at Cleveland Clinic's Center for Men's Health, male patients can schedule appointments with other providers, including an endocrinologist, dietitian, or cardiologist, in one location and in one visit, Landro reports.

    "We want to be a one-stop shop and encourage men who might not be thinking about the risk of heart disease," said Eric Klein, chair of Cleveland Clinic's urology and kidney institute.

    Hospitals design men's health centers to appeal to males

    In addition to providing male-focused care in one location, hospitals often are designing these centers to foster a male-friendly environment, Landro reports. 

    For example, Mount Sinai Health System worked with the design nonprofit Man Cave Health to launch a sports-themed men's health center. The center's waiting room has TVs playing sports programs and showcases memorabilia from local sports teams in an effort to "make men feel at ease" about going to the doctor, Landro writes.

    UCLA Medical Center's Men's Health Clinic took a more gender-neutral approach to their design, using "simple, streamlined furnishings," Landro reports. "L.A. is a very diverse population with a large portion of people who aren't gender-conforming, and we want to make everyone comfortable," said Jesse Mills, director of the medical center. "My goal is to break through the stereotype of what it means to be a man in the first place and get men the health care services they might not even realize they need."

    Steven Lamm, an internal-medicine physician and medical director of NYU Langone's Preston Robert Tisch Center for Men's Health, said NYU Langone's adopted a more corporate design to help attract younger patients who treat the center as a source of primary care. "I will tell them, I know you came in here for bronchitis, but let's talk about why you can't skimp on sleep," Lamm said (Landro, Wall Street Journal, 4/29).

    Advisory Board's take

    Sarah Musco, Senior Consultant, Service Line Strategy Advisor

    As this story shows, men are often far more reluctant than women to seek out medical care. And this has real implications for providers—men spend approximately 21% (or $1,600 per person) less on health care annually than women, although 48% have at least one chronic condition. Men also face a number of unique health issues, like prostate cancer and erectile dysfunction and have twice the risk of a heart attack (even after controlling for other risk factors) than women.

    Our research has shown that men's health care utilization is primarily inhibited by two factors:

    1. A perceived lack of value in seeking care before acute illness: Survey results show that men often wait until they are already very sick to see a physician, and that many are not convinced of the value of preventive services.
    2. Societal gender norms: As the article above mentions, many men face societal pressure—both real and imagined—to portray strength. Survey data show that men who idealize the concept of masculinity are 50% less likely to access preventive health services. And, once men get to the doctor, many feel embarrassment about talking about sensitive issues like sexual performance.

    In response, organizations have begun re-envisioning care delivery for men, and focusing on consumer-friendly models that focus on "whole-person" health. Whether these approaches are centered on primary care, focused on urological or sexual health, or take a comprehensive, multispecialty approach, all can help advance an organization's strategic goals.

    For instance, health systems commonly cite the below goals as reasons they developed a men's health program:

    1. To better manage population health. Increasing men's access to preventive care can help to keep half of the population healthy and avoid future admissions—a key tenet of population health.
    2. Tap into men's health with minimal investment. With margins getting tighter, targeting men can help attract new patients without high new investment costs. In particular, primary care or prevention-focused clinics often have low infrastructure and staffing requirements.
    3. To increase downstream procedural volumes. Engaging men in conversations about their urological health, for example, can bring them into the health system and drive lucrative downstream specialty care.
    4. To improve specialist collaboration. Getting physicians to collaborate effectively is often an evergreen challenge for health systems. Centering programs around men's health, and including a variety of specialists around their care, can help improve specialist communication and care coordination between service lines.

    To learn more about different models for men's health programs, including the options for care delivery methods and our three key aspects for making your program successful, download our primer on Men's Health Programs.

    Download the Primer

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