Over the Counter, Under the Rug: Why aren’t men going to the doctor?

BY JOHN FELDKAMP

Illustration by Nishant Choksi

Seated on the rusted bed of a weathered Ford, towel in my mouth, and pinky bent in a peculiar direction from a rugby kick gone horribly wrong, I writhed in pain as my teammate poked and prodded at what I assumed was a horrendously-dislocated finger. When he finally wrenched my swollen, disfigured digit back into place, two thoughts circled my mind:

Can I go back into the game?

How is this going to affect my bench press today?

With my ring and pinky fingers buddy-taped together, I figured all was well and went on with my day — which included a rigorous workout session. Over the next several weeks, I ignored the constant pain and promptly learned just how important the pinky is for everyday activity: from writing to deadlifting. Waiting so long to be medically evaluated caused my finger to heal incorrectly, even after surgery and steroid injection, and gave way to permanent stiffness and immobility. 

X-ray showing complete fracture of the proximal phalanx of my little finger.

In similar fashion, just years later, rigorous overtraining in powerlifting caused a disc bulge in my spine. After ignoring the pain, refusing to be evaluated, and continuing to compete for over a year and a half, my L5-S1 spinal disc herniated.

MRI showing the protrusion of the gel-like nucleus from the annulus of the disc pressing against my spinal cord. 

In simple terms, the gel-like substance (nucleus) between two vertebrae in my lower back has protruded out of the protective disc (annulus) and is now pressing against my spinal cord. This is a very painful and serious injury that, in many cases, does not heal without surgical intervention. It makes any flexion of the spine, even sitting in a chair, extremely uncomfortable. 

With countless injuries coupled with medical anxiety and a need for therapeutic intervention, I have always felt a resistance to utilizing the healthcare system; and it has caused me chronic pain, mental anguish, and permanent physical limitation. Underneath my apprehension was a deep-rooted patriarchal fixation on needing to feel autonomous, invulnerable, and without need of repair. Within a gender so harshly affiliated with work, I find it ironic that we as men so often fail to do the “work” of routine checkup, acute injury care, and psychological therapy.

Does this sound familiar?

Why am I, a man who is enamored with the medical profession, so hesitant to go to the doctor? 

Me and members of our medical class giving our class oath following the presentation of our white coats.

Much like the Farmer Pain Scale, there’s an old medical adage I’ve heard that goes like: “You know a male patient’s injury is serious when their wife didn’t have to force them into the emergency room.” This lighthearted remark takes aim at a greater issue. If you find that this resonates with you, or you’re frustrated by this characterization of men, hear me out. We are, systematically, awful at taking care of our health. 

A longitudinal study of Australian men aged 18 to 55 found that the majority of men do not engage in regular health check-ups. These regular screenings are designed to survey for common ailments, such as cancers, as well as voice concerns, refill medications, and serve as an opportunity for referral to a specialist, like a psychiatrist. Not surprisingly, then, we find that deaths from melanoma are 50% higher in men than women, despite the fact that the disease occurs 50% less in men. This is almost entirely explained by the fact that men are less likely to have their concerns evaluated in a timely fashion. Furthermore, the American Foundation for Suicide Prevention estimates that men die by suicide at a rate nearly four times that of women. Countless other statistics demand our attention to the issue, but none more flagrant than this: Harvard Medical School estimates that men live 7 years less than their female counterparts. This fact is anchored to a vast disparity in routine health visits, heart disease, biological complexity, social isolation, risky behavior, and more. 

So why aren’t men going to the doctor?

The aforementioned symptoms are piloted by a familiar foe: a patriarchal hierarchy that commands us to find our own way, using our own strengths, and displaying the utmost machismo in the process. Because our value is determined by our ability to “provide,” men hold a general carelessness toward their own health. This seemingly-selfless act is actually naive; as we can’t provide when burdened by the accumulating sickness and injury that we won’t have treated. The provider archetype itself is also a bane to getting men into the clinic:

“I can’t be sick or injured because I’m the provider and if I’m not around, the family will fall apart. And if I don’t get a check-up, I can’t be sick or injured.”

Sound familiar?

Further, the social ladder created by men perpetuates the concept that self-care is either feminine or “gay,” both of which are seen as the bottom rungs of the masculine hierarchy. As such, going to be evaluated in a male-dominated field requires us to be vulnerable in front of another man, which is a direct breach of the patriarchal contract we are held under from childhood. Simply asking for help requires us to admit that we are not perfectly capable of finding our own way, which is an unacceptable proposition. To my male readers, consider this: When was the last time you were lost and earnestly asked for directions? 

Further, there is tremendous stigmatization of mental health and psychotherapy as this mystic, feminine concept that requires men to detach from our inherent logicism and enter into the void of emotional experimentation. Even being labeled as having a mental illness would require a man to admit that he has feelings. It is also a new dimension of challenge, one that requires us to look beyond acute fixes, and evaluate ourselves from the lens of mindfulness, which is not a perspective that is in agreement with our pre-existing, self-deprecating thought pattern. Many men see themselves above therapy altogether, and don’t see that our brain, much like our heart, is an organ wholly capable of contracting illness.

There exists in men, especially those from hypermasculine environments, a unique paradigm, one where the “alpha male” (itself a debunked concept) perspective of constant self-improvement is prioritized in all aspects of life except the most consequential: healthcare utilization. We obsess with the gym, grind for “sexual market value,” and look to be immortalized in financial prowess. Ironically, but not coincidentally, we deprive ourselves of what we need the most: nourishment of mind and body. And it is quite literally killing us. 

The philosophies touted by pro-patriarchal figures stress a dogma of relentless self-mutilation; i.e., “You’ll sleep when you’re dead,” not knowing that sleeplessness is the reason so many men are not able to improve in other aspects of life. Our bodies are the vessels by which we carry out our desires. By honing in only on the desires themselves without routine maintenance on the body, we are destined to break down. In fact, many of the self-titled prophets of this system will blame your perceived failure on “not doing enough,” thus initiating a hopeless spiral. They’ll say that the scars of a man are merely a trophy to be worn with pride. I promise that melanoma, heart disease, and suicide will not greet you with salutatory applause. 

Men, your bodies and minds are not simply a means of production. Though our values systems may have taught us that it is  “manly” to tough it out, I need you to see what toughing it out has done to me, and what is doing to us all over the world. I ask you to take care of yourselves, bandage your wounds so that they don’t become battle scars. You don’t need to learn lessons in the form of disfigurement, psychic self-mutilation, and chronic pain. If you idolize strength, idolize it enough to recognize that it takes strength to go to therapy. To admit to your physician that you are struggling. If you wish to be the best provider, recognize that this means providing for yourself. Whether it be for a prostate exam or a herniated disc, honor your body and see a healthcare professional.

I know that you are exhaustively asked to harden your resolve, but I’m asking you now to soften your heart.