PCL38: Every Man Needs a Urologist

A Conversation with Dr. Charles Modlin of the Cleveland Clinic about the MENtion It Survey 

As legend has it, ABSOT originally began as a guide for newly-diagnosed testicular cancer patients - the resource I wish I had had when I first heard the words, “You have cancer.” However, the mission changed into educating the general public about the importance of discussing men’s health when I found the 2016 MENtion It survey done by the Cleveland Clinic. This was one of the first surveys that showed clearly that men don’t always necessarily take their health seriously, and I incorporated into one of the first pieces on ABSOT about my reluctance to call a doctor.

Since then, I’ve referenced those stats multiple times in my writing and awareness work but never had personal contact with the Clinic. A few weeks ago, I was pleasantly surprised to see the results of the 2018 MENtion It survey land in my Gmail inbox. Now in its third year, the theme of this year’s survey is analyzing how men’s health is influenced by female spouses.

The email also mentioned an opportunity to speak one-on-one with Dr. Charles Modlin, a urologist at the Cleveland Clinic and the founder/director of Cleveland Clinic's Minority Men's Health Center. I eagerly accepted the offer, which led to the following fantastic conversation.

Discussing how the the Cleveland Clinic came to be a pioneer in men’s health with the MENtion It campaign

Click to enlarge and share

One of the first things I asked Dr. Modlin was why the Cleveland Clinic started this push for men’s health. A few years ago, the Department of Urology in the Cleveland Clinic noticed that men historically “have, in many respects, shunned doctors, and a lot of times they don't want to go to the doctors. They ignore signs and symptoms of certain diseases they may have. As long as they're able to get up, go to work, and aren’t in severe pain, they'll just say, ‘There's nothing wrong. I don't need to go.’”

Dr. Modlin postulated why this may have occurred: “A lot of men were taught to be stoic, to be macho, to grin and bear it, to just deal with and ignore pain, [whereas] women have been educated at earlier ages that if they sense there's something wrong with their health or their bodies to go get it checked out.”

Realizing all of these factors, the Cleveland Clinic started the MENtion It campaign in 2016 to do more to encourage men to take better care of themselves.

Discussing differences between 2016 and 2018 MENtion It surveys

The 2016 MENtion It survey found that 53% of men don't talk about their health, and in 2018, that had slightly increased to 56% of men preferring to keep health concerns to themselves. 2016’s survey showed that 40% don’t attend their yearly physical, while the 2018 edition said that 61% of men have neglected visiting a doctor even when they needed to go. In this year’s study, it was also reported that 83% of women said they encourage their spouse/significant other to get their health checked once a year, but 30% of men believe that they don’t need to go because they are “healthy.”

I asked Dr. Modlin about his opinion on why these stats don’t seem to be improving. He said, “he fact of the matter is, it still suggests that over half of men are reluctant to speak to others about their health concerns, to speak to each other about their health concerns, [and] to admit that they even need to get checked out, even if they do have signs or symptoms.”

Comparing the results of the 2018 MENtion It survey to other testicular cancer studies

Click to enlarge and share

On a good note, the 2018 MENtion It survey also mentioned that 59% of men would see a doctor promptly for changes in their testicles and 49% of men would see a doctor immediately for testicular pain. However, the majority of men aren't actively looking for these problems. The survey found that only 41% of men under the age of 35 regularly do testicular self-exams. This aligns with findings from the CACTI study from earlier in 2018 (more than 1 in 3 of all men polled have never been told about the importance of a monthly testicular self-exam) and a 2016 study by the Testicular Cancer Society (only 42% of men know how to do a self-exam).

When asked for his reaction to these studies, Dr. Modlin stated that he was surprised that the statistics were that high and would have assumed that they were lower. I also shared the study ABSOT ran that found that 78% of men weren’t taught how to do a self-exam at their most recent physical, and asked why the ball has been dropped on this particular information.

“Medicine is changing and in a certain way that is actually putting more pressure on primary care providers to do more during their encounters with the patients in a shorter amount of time. They're trying to manage the diabetes, the hypertension, high cholesterol, heart disease, stroke prevention,weight management, behavioral health, the medications and all that kind of stuff… in a 15 to 20 minute interaction that is allotted to them. It [also] requires that doctors spend more time doing documentation and it's taken away time from the face to face encounter interaction between doctor and patient.”

As a public school teacher, this made total sense to me. Just like I’ve felt pressure to do more with less, doctors are feeling many of the same stressors. In either case - this isn’t an excuse; it’s simply the reality of our society.

Identifying a problem in men's health awareness is important, but working to a solution is critical

ABSOT’s mission isn’t just to bemoan the state of men’s health - it’s to improve the care and attention it receives. I asked Dr. Modlin how healthcare professionals and health activists can work together to right this course. He suggested a three-pronged approach.

1. Every man needs a urologist:

I used to joke that I was 25 and had a urologist, but Dr. Modlin said this should be the norm, not the exception. He didn’t mean that urologists should replace primary care physicians; they should augment care. The primary care physician can focus on the aforementioned general issues and allow the urologist to focus on men’s health issues, similar to how gynecologists work in tandem with women’s doctors on their specific needs.

For this to be successful, two things need to happen. We must begin educating people that men need to start seeing a urologist far before the traditional 40’s/50’s timeframe. Dr. Modlin said as early as 15 (the same age in which testicular cancer begins to become more common) wouldn’t be a bad idea.

Click to enlarge and share

In addition, the digital age of medical records has definitely helped put collaboration between primary care physicians and radiologists on the right path. Dr. Modlin said that e-consultations and phone calls between the medical professionals are common, but it’s also important for doctors to physically refer patients to specialists.

2. Help men prioritize their health:

On the Titanic, it was women and children first, and men - if there was room. Dr. Modlin mused that this attitude had been adopted throughout society, and though putting others first is kind, it can be deadly when it comes to personal health. Without being politically incorrect, according to him, “historically the men were the ones that went off to war. It was the belief that men were expendable.” This notion that men were expected to endure danger contributes to modern feelings towards personal health.

While healthcare is a personal responsibility, and men need to start prioritizing it, we also need to place more emphasis on men’s health as a society as a whole.

3. Go where the men are:

I always find it ironic that my analytics on ABSOT and Instagram show that my viewership is primarily women. While it must be my endless charisma, my roguish good looks, and the allure of what a man with one testicle must be like, sadly, they’re not my target audience. This isn’t surprising however, since the major users of most social media are women (with YouTube being a notable exception).

We need men talking with men about men’s health where men are hanging out with other men - places like work, barbershops, gyms, bars, and places where sportsing happens. If you look at the world through my eyeballs, you’d be amazed how many opportunities for talking about balls and other men’s health issues present themselves in these areas.

According to the 2017 American Time Use Survey, men spend more time than women do working, exercising, and watching television. While the above mentioned ideas cover the work and exercise components, a push for national media coverage would help reach the men who watch TV or stream online.

Dr. Modlin and I agreed that there needs to be a collaboration between healthcare professionals and men’s health activists to make this work. My voice alone (as someone who is seemingly obsessed with testicles) doesn’t carry much weight by itself, just as a medical facility’s message can be augmented with a “Regular Joe Everyone” voice.

Let’s join together to grab this mission by the balls and make it into a reality.