In fact, I probably achieved the lowest mark in an exam ever obtained by any student before or since in any subject. To say I was red with embarrassment is an understatement.
A number of years later I had the same experience studying dermatology at medical school and had to do remedial zits over the summer. Once again, embarrassed. Bright red. But I do remember learning about a condition called Mycosis fungoides, a form of skin cancer that can, in extreme cases, cause patients to be red all over. And as the condition is much more common in men, it has earned the epithet l’homme rouge, French for “red man.” And just as Columbus stepped tentatively on to American soil, so patients with mycosis fungoides tend to step tentatively to their doctors, often taking 7 to 10 years of dealing with distressing symptoms of red and profoundly itchy and flaky skin.
This tentative behavior is not unique to the above condition, but rather the male of the species. We all know the old joke: “Why is it that men live a briefer existence than their spouses?” And the sarcastic answer? Because they can. But this hides a real and serious issue. And pilots are especially prone to this sort of behavior. Yes, we have to get regular medicals to continue to fly, the nature depending on class of medical sought. But because the AME may not be the aviator’s regular doctor, not everything may be disclosed, and often pilots will defer seeking medical opinions in case they hear bad news in the hope that the problem will go away. However, hope is not a good strategy in an aircraft or with your body!
Recent statistics from Britain between 2017 and 2019 demonstrate that men shuffle off this mortal coil 4 years earlier than women on average and also suffer far more gender-neutral diseases like hernias, aortic aneurysms, and kidney stones. During the COVID-19 pandemic, 2.8% of men are dying compared with only 1.7% of women. This gender health gap exists across time, societies, and space – even as lifespans have increased overall, the gap remains. But why does this gap exist and what are physicians doing to help rectify the imbalance? I can categorically state, as a doctor, a pilot and a man, that we are just not good at keeping tabs on our health. Women are better at this than we are. The reasons, though, are complex.
The most dangerous thing you can put into a car is a teenage boy. And the next most dangerous thing you can put in a vehicle is…two teenage boys. As a result of data, based on years of experience, insurance premiums for boys are higher than girls. Why? Simply put, men are at bigger risk of accidental death than women because they tend to take on silly risks and more dangerous activities and pastimes—think motor bikes and extreme sports. I am leaving out aviation here – for one thing, there are far more male than female pilots and I like to think of flying as a safe pursuit. Additionally, I am not being sexist, it is just a fact.
One example? Although the percentage of women riding motorbikes is rising – currently around 20% – female bike accident patients are less often drunk, more often wore helmets, were transported by emergency medical services, and arrived at the emergency department during the day compared to male patients and had a significant lower “Injury Severity Score” (a way of evaluating multiple injuries) and adjusted odds ratio of dying during their hospital admission. Additionally, far fewer female patients were admitted to the intensive care unit, or ICU, and female patients had a significantly shorter hospital and ICU length of stay. All in proportion to bike use. I rest my case, your honor!
And one can also consider jobs like working on oil rigs, as firefighters and in active military duty. Of course, social and political mores have historically dictated that women should not be exposed to such risks, but that is changing and may even reveal some sex-related mortality differences.
But there is another, major cause and for that I would reference three friends of mine; Richard, Tom and David. All very smart. One a surgeon, one a lawyer, one a talented artist. Colon cancer. Pancreatic cancer. Coronary artery disease. All three dead. All three might have been saved if they had acted and SEEN. THEIR. DOCTORS. But they didn’t.
Men embrace risky behaviors in many areas of their life and healthcare is no different. Psychologically, men take health behavior risks that influence outcomes by acts of omission as well as the acts of commission I have referenced. Simply put, men are much less likely to visit a doctor when they are ill, or to undertake wellness visits. Even when they do see a doctor, men are less likely to report symptoms. Efforts to influence risky behaviors abound – wear a seat belt, don’t drive drunk and so on. I strongly believe doctors need to do more to encourage men to see us and set embarrassment and machismo aside – being tough may play well in Peoria, but does not play well in the cemetery. And I strongly encourage all the men reading this to set their prior beliefs aside and take action; that is the act of a real man. A pilot, steering the course to his own best life.
You can email Jonathan at [email protected] with suggested topics for future articles or any questions, which he will endeavor to answer. You can also listen to Jonathan’s weekly podcasts on medical matters at the EMG Health Podcast available on iTunes, other podcast platforms and https://www.emg-health.com/omnipresent/podcasts/emg-health-podcast.
