A complete examination

Slowly but surely, preventive medicine is gaining popularity. Though some insurers still resist the idea of paying for tests and other care associated with an illness that might never happen, many are coming to believe that it's cheaper to pour money into early detection and prevention than it is to pay for expensive treatments after the onset of an illness.

Preventive care for women care is well-established; screening for breast cancer, for example, has become routine. For men it's relatively new. Still, more and more health care providers are sponsoring free screenings and bolstering their educational and informational efforts related to men's health issues. In the process, they're trying to determine the best ways to communicate to men the value of early detection and prevention.

Once such provider is Methodist Medical Center, Dallas, Texas. The 463-bed regional teaching and referral hos-pital is a member of the three hospital nonprofit Methodist Hospitals of Dallas system. Carol Beck-Edgar, assistant vice president, public affairs, Methodist Hospitals of Dallas, says that the hospital distributed a short survey to men who came to the hospital last year for a free prostate screening to find out their attitudes toward a variety of health care issues. "What the survey pointed out is how much we didn't know. We have men's health services, but the question is, are they truly marketable to men? Can we get men in the door?"

To answer those and other questions the hospital, working with Dallas-based Savitz Research Center and Gail Hartsfield of Hartsfield & Ascts., held focus groups with men and women in four categories: men ages 40-70 who had had some medical treatment (not accident related) that required them to spend time in a hospital; men 40-70 who had had no medical treatment experience; the wives of men ages 40-70; and a group of men ages 50-70.
 
"We asked a series of questions to discuss their feelings toward physicians and hospitals in general, to find out where they got their health care information and to find out how much information they had about major diseases," Beck-Edgar says.

"Both men and women were asked roughly the same questions. For instance we talked about male-related diseases. Men are most informed and up to date concerning prostate. They knew more about that, the problems, the symptoms. Men knew what a urologist was but I think we had a perception going in that more men would relate to a urologist sort of as the man's OB-GYN but they really didn't."

Michael Kassab, vice president, Savitz Research Center, says that Methodist had four objectives going into the research:

1: To determine how men would define a men's health services program and evaluate their level of interest in such a program.

2: To learn more about men's attitudes towards health care and deter-mine what factors would motivate them to seek medical care.

3: To determine their level of knowledge of specific men's diseases and treatment alternatives.

4: To determine to what extent health and medical services were marketable to men.

"We wanted to find out how continued advertising would be received and whether our target was right," Beck-Edgar says. "We also wanted to find out what services we had offered or could offer that would be more marketable to them."

Resistant to talking

Initially, Kassab says, it was feared that the men would be resistant to talking to the moderator and other participants because of the sensitive nature of the discussion. But that wasn't the case. "The men were very open and willing to talk about their health. I attributed that to the new trends in health consciousness. They didn't feel that it was demeaning to discuss their health with the moderator," he says.

"Focus groups are the setting that you have to use in exploratory research like this. When you want to explore the attitudes and opinions, they're by far the superior method for trying to understand what motivates a particular audience. Because you can sit and discuss it at length and go into detail about certain issues and you have play back and forth between participants and the moderator."

Part of the mens' openness stemmed from the presence of a female moderator, Kassab says. "We thought the respondents would do better with a female moderator. We made some judgment calls on this project, one of them was using a female moderator. That was a big decision and it turned out real well. We felt that she would do better than a male moderator and she did. They opened up to her entirely."

Major distrust

During the groups, the men expressed a variety of beliefs, opinions, and fears about going to the doctor. Some findings:

The level of experience with physicians and hospitals seems to have a powerful influence on men's attitudes about health care. There is a major distrust of physicians, especially among the men who haven't had any medical treatment. In general, those who have been hospitalized were more trusting and they also were more convinced that preventive care is a good thing, Beck-Edgar says.

"One of the things that came up is the fact that very few men have a reason for going to the doctor until they get sick, unlike women. Women have to go, usually because of birth control and things like that."
Kassab: "Men are relatively healthy until age 50. They are naturally disjointed from the medical field and highly distrustful of it - in marked contrast to women, who tend to believe in their physicians and the hospitals. Men have a distrust of physicians and a lack of confidence in hospitals. They view the office visit as a tremendous inconvenience.

"In the focus groups, the 65 and older men who had had health problems didn' t necessarily have a 'healthy living' attitude. But now that they've had some medical problems they look back on their lives and acknowledge the impor-tance of preventive medicine. They did not necessarily share in earlier years the healthy living philosophy held by most young men today, but now they're big proponents of it."

Communication a problem

Some of the men, echoing a common complaint of women, said that communication between the physician and the patient is a problem, Beck-Edgar says. "(The men) feel that they don't get the answers they need from physicians, or if they get the answers, that they're not in language they understand."

But in terms of the patient-physician relationship, the emphasis for the men is not on the "warm fuzzies," Beck-Edgar says. Men are more concerned about the expenditure of time and money a visit to the doctor requires. "A man, especially a businessman, feels that if he's taking time off of work, and he's being paid X dollars per hour, then the doctor that he' s paying $75 or $ 100 can "*" darn well spend that much time with him. They feel, Tm paying for this guy's time, I want more of it.'"

Wives' role critical

The research found that the wives and significant others of the men play a critical role in getting the men to their medical appointments and in informing them about medical issues. "In a lot of cases," Kassab says, "the wives gave us tremendously good insight into the feelings of the men. They filled in a lot of the gaps. They told us stories about what it's like trying to get their husbands in for an appointment. The husbands were saying to us, 'Yeah, healthy living is important, you have to watch your diet.' Then we talked to the wives and they said, 'Well, the men talk that way but you still can't get them to go to the doctor.' They said, 'I literally have to make his appointment and pick him up and take him there to get him to go.'" The reasons for this reluctance, the women suggested, include the man's fear of appearing weak or dependent and the fact that many men would simply rather not know if they're ill. "There's a tremendous fear factor of knowing they have an illness and an aversion to admitting weakness. Men continue with those attitudes until they experience some kind of illness, at which time their opinion seems to change dramatically," Beck-Edgar says.

The women are also sources of information, Beck-Edgar says. "They tend to read and point out things in articles. In the focus groups, men said they discuss health problems with other men, but they don't discuss it very often with their wives or significant others. The women did not seem to be aware that men discussed health problems at all. It's still a macho kind of thing."

Package deal

Beck-Edgar says that when asked about what might make them respond to an ad offering a screening or a checkup, the men seemed interested in a kind of package deal that delivered value for the amount of time spent. "No cost" or "low cost" were important phrases for them. "They said, 'Can I come in and get all this stuff checked over at a reasonable cost, sort of like when I take my car in?'

"We're going to have to take a look at the way we package our services and the way we provide them so that perhaps men will take advantage of a comprehensive executive package, for example. We know that they respond to the word free. But we need to figure out how we can get them to take maybe a morning and get a full check-up. That's where we're still working. I think one of the keys is going to have to be that 'time is money.'"

The younger men seemed to be more conscious of their health and of the benefits of a healthy lifestyle.
"Younger men are more attuned to healthy living than probably their fathers were at that age. They're probably more aware of healthy living. They're the ones who have joined the health clubs and who are into the healthy diet," Beck-Edgar says.

Kassab: "The male stoicism of older generations seems to be giving way to the healthy living younger man. Basically, men were more interested in their own health care than what we expected. And we really felt strongly from the results that there had been a change going on, a trend toward more healthy living. Most of the the younger men in the 40-50 age range seemed to be conscious of their health and readily admit to the fact. They talked a lot about the importance of taking care of oneself and the importance of diet and exercise and avoidance of excessive bad habits.

"But the healthy living philosophy only goes so far with men, even the younger ones. They have the philosophy but in almost all cases it's still not strong enough impetus for them to seek preventive medicine or to even get medical treatment for some illnesses until absolutely necessary. Some men still don't have a doctor, nor do they get check-ups. There are a relatively small group of men who practice preventive medicine with regular physicals and testing but even there, many physicals coincide with illness or are given to them by their company."

Concentrate on women

Beck-Edgar says that the hospital is still in the process of determining what actions to take based on the focus group results. "I'm looking at a program now for consumer advertising. We're going to have to concentrate on the women to a certain degree. We're going to have to consider physician-to-physician referral and re-educate the physicians a little more as far as what their patients want and what they expect.

"One of the keys for this year is to provide the educational materials. It's going to be a slow building process. It's not something that you can hurry. Like the water hitting a rock, how many times do you have to hit it before you make an impression? Fifty men aren't going to come in for a screening the day they read the ad. It might bring them in when they see a symptom that bothers them or when they have a problem or a friend has a problem.

"I think that men are going to think more about health as they are hit in the pocketbook, as consumers and as employers who are fighting health care costs. And I would hope that the trend in the insurance industry becomes that of prevention and screening versus paying for it once it's been diagnosed.

"It's the problem that we have all the way along, that certain insurance programs will pay for very high tech treatments but they won't pay for the preventive medicine that would prevent those problems to begin with. So I think that as men see that prevention and regular check ups, just like going to the dentist, can prevent major problems later, things will gradually change. But they're not going to change overnight."





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