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At the heart of general practice since 1960

Sometimes I only get one shot at getting it right

Men, particularly working men, are not very good at coming to see the doctor.

Men, particularly working men, are not very good at coming to see the doctor.

It is not as facile as their employers not being keen to release them, it is more complex than that. Men just don't want to go to the doctors, and I should know because I am one (a man, that is).

Men will consult, however, if there is something fairly obvious, such as chest pain or coughing up blood.

I regularly get men who come up to see me and tell me that the only reason that they have attended is because their wives/partners have persuaded them to come up.

If it is difficult to persuade professional men to attend the doctors, then it is much harder to persuade the average worker to come up. It is not in their make-up to see that it is necessary, and there is a weakness in a machismo culture that says ‘I can cope' or ‘it is nothing'.

I do however think that they are more likely to come up and see me, as they might think that I, a male GP in middle age, would be sympathetic, or might have similar problems. This particularly becomes evident when they sidle into my room to talk about erectile dysfunction.

The biggest problem with men, however, is those who have psychiatric problems. There simply is not a culture where men can actually admit any psychiatric problems, let alone talk about them. So when I see a man who consults with a psychiatric problem, such as anxiety or depression, then the disease is likely to be much more advanced than if it were a woman consulting.

I was reminded of this when I saw a chap with moderate symptoms of depression. He was coping, by his own standards, until about two weeks ago when his wife of twenty years walked out on him to stay with her sister. His behaviour was the issue, and this was all about the features of depression - loss of concentration, loss of interest, extreme negativity, low mood - being quite high up on the list of problems.

It was not the two or three years of depressive symptoms that brought him up to see me, it was the fact that his wife had left. It took him two weeks to seek help, and when he came up as an extra patient, added on to my already copious list, it was one of those consultations that you just knew would take 40 minutes.

The diagnosis is fairly self-evident, although according to the rating scales that we are forced to use in order to make a diagnosis, he was moderately depressed, I was worried. You see, I feel that if I don't get it right on these first consultations, they might not come back, and things then only get worse. Men are less likely to take medication, more likely to default on reattending, and also more likely to be successful if they attempt suicide.

So I get the feeling in these cases that ‘something must be done' and, of course, it takes time for effective antidepressant medication to work. This needs to be explained. It also is the case that if people come and see me after things fall apart, it is much less likely that there will be a rapprochement.

I have a feeling that in these cases I only have one chance to get it right, one choice of anti-depressant, one opportunity to develop a rapport with my patient.

I always worry about men with depression.

Jobbing Doctor Jobbing Doctor

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