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The New York Times recently ran an article, Why Do So Many Men Avoid Doctor’s Visits?

The subtitle is, “Experts share tips for getting over the resistance.”

My question (which I share with many people who wrote comments) is, “Why should they? Resistance could save their lives.”

Anyway, it’s not always the patients who resist doctors. Sometimes they resist us.

Three things especially bothered me about this article:

1 – Both the article and the comments failed to distinguish visits for screening versus visits for symptoms.

There’s quite a bit of controversy surrounding the value of screening tests. In a recent article, I summarized a few sources that question the common wisdom of screening.

Therefore a decision to avoid screening may be quite logical.

Avoiding medical attention for symptoms is another story. If you’ve got severe abdominal pain for several days, many experts would be appalled if you refused to seek care.

However, the comments revealed another side to the story. As several said, it’s not that they avoid doctors; it’s that doctors avoid them. One commenter described a man whose abdominal pain was dismissed as typical of “older” people. A few days later, the man was dead.

The medical system (at least in most of the US) is set up to emphasize and reward so-called preventive tests. These tests work well in a bureaucracy. They leverage the doctor’s expensive time: a low-paid tech performs the actual test. They can be planned months ahead of time.

Because everyone’s so busy with screening tests, there’s no time to deal with an urgent problem. I might like and trust my PCP, but if I get severe symptoms, he won’t be available. I’ll see total strangers in the emergency room and urgent care.

The theory seems to be that, if we inaugurate widespread prevention, we’ll see fewer acute problems. It’s a nice theory but life rarely works that way. I’ve had conditions requiring medical intervention that would not have been picked up in routine screening. Mammograms have a 13% false negative rate. People have falls and accidents. They have heart attacks the day after an EKG. They get cancer in the interim period between screening exams.

2 – Commenters either distrust screening altogether or believe it will be 100% effective.

“If my husband had just gone for checkups,” several women said, “they’d be alive today.”

Not necessarily.

Screening only affects probabilities of illness, usually in very tiny amounts.

The value of physical exams has been found to be small to nonexistent. This article in Time Magazine cites research findings and quotes respected physicians. Physical exams are costly. If we did way with routine exams on symptom-free people, doctors might be able to see people with acute problems faster – and save lives in the process.

3 – It’s not that people avoid doctors. It’s that they avoid us.

The article recommended “finding a doctor you trust.” Commenters pointed out the real question: finding a doctor who’s taking new patients. Doctors move. They retire. They die. They change insurance coverages.

Patients move, too. Even if you want to see a doctor, you wait for many months. For one miserable year, I had insurance that required a primary care doctor. Living in a big city, I couldn’t find a single doctor with at least five years of experience who was taking new patients in the plan.

I had a ridiculous encounter with a very young doctor who told me earnestly, “These tests will add ten years to your life.” I had fractured my arm, which was now turning coal black. Instead of focusing on the arm, the doctor started asking me questions about ear wax. I couldn’t make this up. I wrote about it in my book.

Even if you like your primary care doctor, you probably won’t need her.  There’s little evidence for the value of annual checkups. Preventive medicine is wishful thinking, as I’ve written elsewhere.

If you’re really sick, good luck getting in to see your carefully-chosen physician. You’ll be referred to an Emergency Room or urgent care.

Need a specialist? You have to find the godfather of their first-born child and ask them to make the call for you. Otherwise you’ll end up in the ER anyway.

You won’t be resisting the doctors. They’ll be resisting you.