The current medical rage is the move to electronic medical records (EMR) and the digital practice of medicine. But I’d like to say a few words about some rather different digits. One in particular. Patients may not be afraid of the doctor touching the computer keyboard to bring up their personal information, but many of them certainly are afraid of the docs touching certain personal body parts and telling them that something is wrong. To be specific, men are especially ticklish about another person putting their hands anywhere near their underwear-absent bottom. Computer digits are OK, but human digits to perform the routine prostate exam, aka the single-finger digital rectal exam — no thank you. As Shakespeare would say, “there’s the rub.”
A 2011 Esquire Magazine internet survey sheds some light on this dark place in doctor-land. The survey should not be interpreted as gospel, since it was taken by 519 internet-connected US males, a sampling technique that would tilt the results toward the young and relatively affluent, as well as more educated individuals than might be found in a more representative selection of the male population. That said, it does support the notion that males are touchy about being touched.
When men were asked which medical tests give them the most anxiety, two were tied for the top spot: the digital prostate exam and a colonoscopy, each chosen by 36% of the sample. By comparison, only 23% found a dental checkup to be the most upsetting, and just 5% admitted to being threatened by a hernia exam. Consistent with these results is the fact that only 30% reported having had the rectal (prostate) exam of those men between age 41 and 50 who participated in the research.
What might this suggest about the avoidance of doctors by some males? Conventional wisdom tells medical professionals that stereotypical men identify themselves as “tough” and don’t like appearing vulnerable. They are taught early some version of “the athlete’s creed:” if you are injured don’t complain, rub some dirt on the wound and get back into the game; don’t be a sissy, a wuss, a wimp, a pussy, a weakling, a girly-man or however else being “less than a man” might be characterized. By that standard, going to a doctor when you feel relatively fine is a sign of weakness or fear, a source of shame. And, indeed, there is data to suggest that lots of men do tend to delay seeing physicians even when they are sick; at least until some time passes and the distress can’t be ignored any longer.
The digital advances brought by computer technology (rather than the MD’s advancing digit) hold no such threat. Time will be saved by your doctor having immediate access to your medical history, a record that is not dependent upon your memory and that will be available on the desk top of all your physicians. Drug interactions will be more easily avoided and all the specialists should be able to smoothly coordinate your care as the team that they must be. Computers may even help in suggesting diagnoses that are consistent with your recorded symptom profile. Medical errors will be reduced. All the computerized data will also make medical research easier.
What medical apps won’t be able to do is get you to make an appointment with your doctor if you are afraid of either what he might do to you or what he might say about your condition. Many people would prefer to assume that if they feel good, doctors can be avoided. They like to think that the medical community is too much like any other business and that what passes for evaluation and treatment is just another way to make a buck. Trust is needed if you are going to put yourself in the doctor’s hands. Literally.
But what would make the digital rectal exam (or its even more invasive cousin, the colonoscopy, in which a tube is inserted into the colon through the rectum while you are under sedation) particularly scary? After all, the former takes just a few seconds, the doctor uses a lubricated glove to do it, and it isn’t painful. Well, probably a couple of things. First, men and women generally rate cancer as the disease that they fear the most. Since possible cancer detection is the usual reason for the routine digital rectal exam in men, it could be one of those things that men believe to be better left alone. In other words, don’t look for trouble and “if it ain’t broke, don’t fix it.”
But, there is more. And if you haven’t figured it out yet, it might just be an instinctive fear of assault from the rear. It is probably scary enough for many men to stand with their private parts exposed to another man, but likely even worse to be positioned with your back to him while he enters you. I’m not talking here only about homophobia, but equally about an instinct for self-preservation causing a kind of automatic terror of being injured. “Wild Bill” Hickok, the legendary gunfighter of the Old West, is a possible example of this kind of concern. Hickok is said to have always been careful to sit with his back to the wall. But on August 2, 1876 he joined a saloon card game where the only remaining seat placed his back toward the entrance. Twice he asked others to change seats but no one did. He was shot in the back of the head by a man entering from the door, just as he feared.
Lots of my male patients postponed or avoided the kinds of examinations that I’ve described here, even quite a number who knew very well that it was a good idea to get them. Some were ultimately persuaded by their wives to go to the doctor. Others might have been influenced if one appealed to the desire to be around long enough to care for their family. But, part of the dilemma is that men tend not to talk to potential persuaders about matters as private as this. And, if you don’t have a doctor (45% of the Esquire sample did not) he cannot advise you to do what is needed.
Clearly, early detection of serious medical problems represents a desperately important area for research into how to motivate terrified folks to do what is best for them. As much as we read about the advances expected from digital medicine, it might be useful to hear a bit more about what is being done to reduce the fear of medicine done with digits; a fear that remains in the shadows — an “unmanly” quality in some of the very same men who portray themselves as macho. If, as I’ve suggested, men avoid these tests out of age-old instincts for self-preservation, one can only be struck by the irony that their efforts at such self-defense increase the chance of an early and avoidable death.
As with all such sensitive and very personal areas of life, however, there is always room for a joke. My own physician told me the following:
I had a patient who came in for a routine digital rectal exam as a part of his annual physical. After that portion of the evaluation was completed, he asked me a question: “Doc, how many fingers did you use?” “One,” I answered. “Why didn’t you use two?” “Because the exam is done with just one finger,” I said. “Yeah, I know, but I wanted a second opinion!”
For a very funny, but also serious take on getting a colonoscopy, read Dave Barry’s A Journey Into My Colon — and Yours. The top image is called Index Finger by Cherubino, sourced from Wikimedia Commons.