Friday, June 29, 2012 • 2:39pm
If you hear the words "integrative medicine" and immediately dismiss it as alternative hokum, you're certainly not alone. Over the past 20 years, however, patients and doctors alike have been warming to the holistic approach of integrative medicine, which looks to treat the whole person—not just a disease—by caring for the mind, body, and spirit, all at the same time.
To get a glimpse at the state of men's health in America today, consider these statistics shared by Joseph Tribuna, MD, Program Director for Overlook Medical Center's Family Medicine Residency: 48 percent of men don't exercise, and 33 percent are obese; 30 percent have high blood pressure; 22 percent smoke, and 32 percent consume five or more alcoholic drinks a day—and one in three men doesn't even have a primary care physician.
"The goal of getting men to see a doctor regularly is to identify potential problems before they arise and help them maintain their overall health, but I know that's easier said than done," says Tribuna. In fact, many men avoid the doctor's office because they don't want to be subjected to a battery of tests. Although certain screenings and tests may be necessary, getting to know a patient and his lifestyle is usually the first order of business. "I usually start well exams by establishing a rapport with the patient and talking about his history," says Tribuna. "This can be just as informative as diagnostic tools." A typical conversation will include questions about a patient's personal habits: Does he exercise regularly? What is his diet like? What are his sleep habits like? Does he use tobacco products or drink heavily? The discussion also will include a review of the patient's medical history (including any vaccines that need updating, like pertussis, tetanus, and influenza), chronic conditions he may currently have or struggled with in the past (including STDs), and his family history. "I also spend time talking with men about their jobs, relationships, and families, and the stress that often comes with these responsibilities," adds Tribuna.
After taking a medical history, Tribuna performs a full physical exam and orders additional tests. Although each patient is different, most exams are designed to create an overall picture of a patient's health by looking at a variety of factors. This includes:
- Blood pressure: "Many men are borderline hypertensive," says Tribuna. "High blood pressure is often silent in its early stages, so this is one of the first things I look at." Tribuna reports that a healthy man's blood pressure is typically below 140 over 90.
- Cholesterol: "Based on a man's medical history, I usually begin doing a lipid panel at age 35," says Tribuna. The cholesterol level is generally considered healthy if it is below 200, but the levels of the different types of cholesterol are important too. Tribuna says he likes to see LDL (bad cholesterol) less than 130 and HDL (good cholesterol) over 40.
- Skin exam: "A lot of hidden issues can be seen subtly on the face," says Tribuna. "I also pay close attention to a man's back, since it's an area he can't examine himself."
- Urinalysis for kidney and thyroid function.
- Weight and body mass index (BMI).
- Testicular exam.
- Colonoscopy, starting at age 50: "I recommend a colonoscopy for every man age 50 to 75, unless he has a family history of colon cancer, in which case we begin screening earlier," says Tribuna.
- Prostate exam: "I discuss with each patient the pros and cons of the PSA test, since the age to begin screening has recently become controversial," says Tribuna.
If this seems like a lot of tests, don't despair. Tribuna points out that it's not always necessary to do every test, like a colonoscopy, annually. "If a patient's risk for a particular disease is low and there is no family history, it may be safe to screen every few years," he says.
Heck no, we won't go
Life-saving conversations and screenings can happen only if men visit the doctor regularly. This is no small obstacle. "In 2007, only 15 percent of men age 15 to 65 had a checkup, compared to 45 percent of women," reports Tribuna. Why the disparity? Several factors likely come into play. "There is a lot less public hype around men's health compared to women's health, so there is definitely an awareness gap," says Tribuna. "The medical community also recognizes that men, like women, are busy, and doctors don't always have the most convenient hours. But in reality, most healthy men don't have to have a checkup every year the way the women in their lives do."
Tribuna suspects, however, that the issues run deeper than simple awareness and convenience. "Men tend to think they are invincible and subscribe to the 'if it's not broken, don't fix it' philosophy," says Tribuna. "There is also a cultural belief that men should never show vulnerability, and that going to the doctor is a sign of weakness." Add to that the notion of having to discuss intimate details about one's body, habits, and sexuality, and it's no surprise that many men simply avoid the doctor at all costs. So how can we change this perception?
"Women do a pretty good job of getting their men in," Tribuna says with a laugh. "But I think the real solution lies in better public education about the importance of regular checkups, and making it easier for men to see their doctors. In fact, the evening hours in my practice tend to be busiest."
Men should consider another point too: The knowledge they gain about their own health can improve the health of their family members. Information like blood pressure and cholesterol levels, risk of heart disease and diabetes, and any family history of cancer can help other family members receive more thorough care from their physicians now and in the future. "The information I learn about a man can be crucial to the long-term health of his children and grandchildren," says Tribuna. "Safeguarding and understanding your health is not just about you—it's about the people you love too."
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