September 2001 • Volume 7 • Number 9
Preventive health care
Are young men tuning out?
Number of office visits (in thousands) by sex and age of patient to all physicians and to general and family practice physicians (GFP).
Male Female Age All Physicians GFP All Physicians GFP 3 - 17 years 58,672 13,720 55,215 13,526 18 - 24 years 12,706 3,928 35,899 9,652 25 - 44 years 66,948 22,660 144,827 32,740
Source: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, 1998 data.BY SHERI PORTER
Where have all the young men gone? Chances are they're not in your exam rooms. The boys that routinely reported for back-to-school checkups and high-school sports physicals probably haven't set foot in your office since Mom last scheduled an appointment.
Their disappearing act is a national phenomenon. Figures published in AAFP's 2000 Facts about Family Practice show a definite dearth of male patients from 18 to 24 years of age (see table).
Is this a worrisome trend -- a precursor to a lifetime of doctor ducking? It's no secret that men are at least 25 percent less likely than women to visit a doctor and are significantly less likely to have regular physician checkups and obtain preventive screening tests for serious diseases.
Or does the dip in numbers merely reflect the reality that this generally healthy population requires little more than acute care treatment with a dash of healthy lifestyle counseling on the side?
MEMBERS WEIGH IN
FP Report asked members of two AAFP e-mail discussion groups to weigh in on this topic -- and they were all over the board in their responses. A sampling of their comments follows.
The boys that routinely reported for back-to-school checkups and high school sports physicals probably haven't set foot in your office since Mom last scheduled an appointment.
- "Considering the little we do for men this age, outside of acute care, it's no wonder that they learn that illness is the only time to see a physician. Unfortunately, most of the risky behaviors we counsel against are considered by our society to be part of the wild oats men longingly recall when they are older. Until we have something they view as useful to offer them, men in this age group will continue to be the 'other person in the room' when we are taking care of their family members." Shawn Griffin, M.D., of St. Joseph, Mo.
- "Men understand the importance of maintenance on their cars -- I tell them to think of their bodies in the same way. They need regular maintenance exams to make sure they haven't developed diabetes or high blood pressure and to look for signs of testicular cancer."Colette Willins, M.D., of Westlake, Ohio
- "I think trying to get young males in for preventive care is a waste of time. They are generally a healthy lot, and screening for chronic health problems in this group is very low yield. Young women go in for their Paps annually, in part to gain access to birth control. Young men have no corollary. When young men seek care for acute problems, a few short questions could screen for some problems. For example, it doesn't take much time to ask if he smokes. If he does, just give a short message asking him to quit, and add an offer to help when he is ready."Rob Reneker, M.D., of Grandville, Mich.
- "In the military, all active duty folks must have a physical examination at least once every five years, which may be enough for this population under discussion." David Hutcheson-Tipton, M.D., Marysville, Wash.
- "I disagree with the idea that these men should seek health care on a per needed basis only. My experience has clearly demonstrated the need for diabetes, hypertension and cholesterol screening on a substantial portion of the Hispanic men in my community whose obesity and family histories often increase their risks of disease."Sandra Guerra-Cantu, M.D., of San Antonio
- "I think a campaign of information about the importance of preventive medical exams is paramount and should be encouraged through employers and on college campuses. Hereditary diseases such as diabetes and coronary artery disease must be discussed with this age group if we want to start counseling that could delay the onset of the very diseases that their parents and grandparents may already have." Viviana Martinez-Bianchi, M.D., of Muscatine, Iowa
- "Any state university that receives federal money should require students to have a complete physical exam prior to enrollment. This should include a review of their immunizations and other health care preventive measures." Carlos Figari, M.D., of Minneapolis
Check AAFP's recently revised recommendations for periodic health examinations. Go online to http://www.aafp.org/exam/ to find recommendations for the general population, as well as important information about screening recommendations for specific and high-risk populations. - "A lot of my young men come to the office for their periodic wellness exams because their wives and girlfriends encourage them to do so. Women are still the consumers of health care, so let's encourage our female patients to get their sons, boyfriends and husbands in for their wellness exams."Darlene Lawrence, M.D., of Washington
- "A better strategy is to target those men with risk factors including obesity, homosexual or promiscuous sexual practices, drug abuse, drinking and driving, tobacco use, and a sedentary lifestyle." Evelyn Fang, M.D., of Fresno, Calif.
THE BOTTOM LINE
"Because most young men don't come in specifically for well-person exams, every acute care contact -- whether it's a minor injury or a respiratory infection -- offers an important opportunity to provide clinical preventive services," said Theodore Ganiats, M.D., of La Jolla, Calif., chair of AAFP's Commission on Clinical Policies and Research. Use these opportunities judiciously, he said, because identification of risks "is critical in providing the appropriate tests and counseling that should be a major focus in this age group."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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