John made an appointment recently. Never seen him before. He shook my hand enthusiastically as he strode into the room. A forced smile. Lots of eye contact. A need to look brave. I remember noticing his hand was a bit wet and his deodorant was working hard. He had flu like symptoms, runny nose, dry cough, sore throat. He had taken a few days off and needed a certificate for this employer. That didn’t explain his anxiety. He seemed to have come to the right conclusion about his symptoms. I examined his throat, listened to his chest, took his temperature and agreed it was probably ‘a virus’ and that he should be fit for work before the end of the week. Then he hesitated. A pregnant pause. Seemed a bit unsure and blurted out those immortal words
There is just one other thing.
I was expecting it. I’ve seen this before. Adult males who exhibit signs of anxiety in a seemingly ‘routine’ consultation. If I’d looked closely I’d have noticed the dilated pupils and slightly rapid pulse. Sometimes ‘John’ comes with a request for a ‘full body check up’. Nonchalantly declaring that he’s getting older. Occasionally he brings his wife or partner, or perhaps they bring him. But when he comes alone the potential agenda is quite short- an embarrassing problem- impotence or sexual indiscretion and a need to be screened for ‘those other infections’, prostatism or something like what brought John in.
I have a very itchy sore bottom.
A life long problem it seems. Been using creams for years. Not helping. Bleeding a bit too. He knew what was coming. Hence the anxiety. The erythema and excoriations around his perineum verified the history. He left with a prescription for a steroid cream and a request to make a review appointment. It wasn’t as difficult as he had imagined. I clearly had heard all this before and he was pleased to be congratulated for being brave enough to ‘do the right thing’. The smile was now genuine. The prescription tucked away into his top pocket. It doesn’t take a lot to work out that there is more to the patient’s need for medical attention then meets the eye. The ‘Flu thing’ is what he tells people why he needs to see a doctor. In reality it’s a lot more serious- not the eczema that remains undiagnosed but the fear that the ‘itch’ is never going to go away and can’t be brought up in polite conversation despite ruining his life. It’s worth offering every man the pregnant pause. They might spit it out, if you’ve done your job right till that point.
Traditional masculine traits intersect with other physiological, sociological and cultural aspects of men’s lives when deciding to seek help. Andrology Australia
Often the patient wears the hidden agenda on their sleeve. No data or app necessary, just be interested enough to notice.
Picture by Drew Leavy