How attractive is your GP?

As the government turns to, amongst others, the MHF for advice on improving primary care services, Dr Graham Archard, vice chair of the Royal College of General Practitioners, talks to Lynn Eaton about whether doctors can make surgeries more male friendly.

For most blokes, going to the doctor for help is as difficult as stopping the car and asking for directions when they get lost. Admitting to a failing is just not something they're wired up for. It's often their wives, partners and girlfriends (sometimes their mums) who'll nag them to see a doctor to get a lump, cough or pain checked out.

Dr Graham Archard, who works part-time as a GP in Christchurch, Dorset, is only too ready to agree that men are backwards in coming forward when it comes to health.

'It's not simply that men are reluctant to visit their GP; it's just that men don't tend to go to see their doctors for screening procedures as much as women. Women come for cervical cytology screening. They tend to take responsibility for contraception more than men. And when children go to the doctor, their mother tends to take them rather than the father.

'As a result, women tend to have a better relationship with their GP because they see them more frequently. They are more prepared to come and see them.'

So, given the government's current review of primary care services, what might GPs do to make their services more male friendly?

Dr Archard admits it is 'quite difficult'. 'Even if we are accessible, men do not come to the doctor as regularly as women. They will come along if they are worried about something, but it will tend to be later than a woman might do.'

Perhaps it is because the GP's bedside manner is different with men, I ask.

'I would like to think we are as approachable to men as to women,' he says, but then reveals that an audit carried out of his own surgery's patients showed that, while women found him open and approachable, his male patients found him a little brusque and apparently rushed for time.

'I was brought up very much with the stiff upper lip,' he adds, trying to explain why, perhaps, he has a tendency to appear less sympathetic with men than with women.

'I'm making a very concerted effort to do better with men,' he says, rather candidly. 'I'm now trying to bring out my female side more when I'm dealing with male patients'.

While a sympathetic GP is important to men, having the surgery open at a convenient time is also vital, judging by initial responses to the Forum's survey on its malehealth.co.uk website. Visitors to the site are being asked what they want from GP surgeries, and longer opening hours or weekend surgeries — to enable men to go after work — come high on the wish list.

'I can understand the argument men make that the surgery is closed when they get home from work,' says Dr Archard. 'But it's a question of priorities. If the Porsche needed servicing they'd find a way of getting it into the garage.'

He's speaking from experience: his surgery has late opening hours, sometimes as late as 9pm, yet it doesn't mean that more men attend. And when — before changes in the GP contract — they had Saturday surgeries, he says, he'd often have people turn up who could just as easily have come during the day on Friday.

New ways of accessing healthcare — walk-in centres or private clinics set up on railway stations — might be more appealing to some men. Maybe men prefer anonymity, I suggest.

'I can see that when they are seeking treatment for something like a sexually transmitted disease,' Dr Archard says. 'But if men are worried enough — that it is cancer or heart disease — they do attend.

'I think walk-in clinics do have a role to play. But don't pretend that what they offer is general practice. They treat simple coughs, colds, flu and aches and pains. General practice is about treating complex matters, difficult physical, social and mental issues. It's not just fire fighting.'

So, if longer surgery hours aren't the solution, what else can you do to encourage men through the door?

His surgery, Dr Archard says, has gone to great expense to make the premises comfortable and attractive. 'We've got nice carpets, paintings, and car and caravan magazines. We've also got a child area. I can't see how we can make it more attractive.'

The malehealth.co.uk survey mentions the need for receptionists to be more friendly. I suggest that maybe there should be more male receptionists?

I sense a little defensiveness as he carefully explains that most of these jobs are part-time and, therefore, mainly appeal to women.

Despite attempts by his surgery to encourage patients to come forward for screening, there will always be a hard core — one that includes some women — who won't set foot through the surgery door, he says.

Recently, his practice held an evening screening session for heart disease and diabetes. The surgery sent letters to 640 patients inviting them to attend: only 140 turned up. 'In fact, we were quite pleased with that amount,' he admits. 'It's not our fault if they don't attend. We can only offer the service.

'You can lead a horse to water… but what else can you do? Men want a fire-fighting approach. They tend not to want the on-going relationship with the primary care physician.'

Does it worry him that they might not be helping men look after their health as well as they might? He answers with the following analogy:

'I drive a convertible car. That carries a health risk if I turn my car over. That is a risk I compute. But I am an adult, I am entitled to take that risk — and so are my patients. As long as they know the risks, it is none of my business.'

Dr Archard believes, however, that men will turn to their GP in times of emotional stress.

'Men may not talk about their problems, but when the going gets really tough, they are more likely to come to their GP. When something starts going horribly wrong with marriages or relationships, then they feel they can talk to their GP without being a wimp.'

Please add your views to the malehealth survey by clicking here. The results will be used in the development of the Forum's response to the government's requests for its help in the reform of primary health care services.

This article first appeared in MHF Magazine.