Men's Health Week 2023

Haider J Warraich, MD, is a cardiologist at the Brigham who specializes in advanced heart disease and heart transplantation. Dr. Warraich is also director of the heart failure program at the Boston VA and an author of several books. In this Q&A, we spoke with him about his experiences working with a lot of male patients and their relationship with healthcare for #MensHealthWeek.

Q: What interests you most about the topic of men’s health?

A: Recently, I’ve been thinking about writing about men’s health, because especially at the VA, the majority of my patients are men. I think there is a need to highlight the unique challenges that men face, and to discuss how we can alter our approach to really reach them. If you look at things like how long men live, men live less years than women (on average, women live about 4-7 years longer via NIH). If you look at suicide risks, you know men are four or five times more likely to commit suicide. If you look at gun violence, men are more likely to perpetuate gun violence and also more likely to be victims of it. Historically, we've seen that when one gender doesn’t do well, it affects everyone else as well and it could have a wider impact on our society and how we progress.

Q: How do traditional ideas of masculinity play a role in men and their healthcare?

A: I think that this idea of men being stoic, of men being self-reliant, it can be at odds with seeking help from healthcare, but I think there’s a way to use some of the core principles of masculinity and reframe them in a way that that can be helpful. It's very hard to be helpful to others if you can't be healthy yourself, and I often use this frame of reference when talking to my male patients. I think for men, being independent is more important than simply just living long enough and in medicine we need to think about how to craft messages that are more effective that men really care about and then create systems that can accommodate them. This is obviously also a generalization, as men, same with women, are not all the same when it comes to healthcare, but there is a sort of bell curve that people seem to congregate around. I agree that there are aspects of masculinity that can promote behaviors that may not be good for men’s health, but I think we can be creative in the ways we engage with men to allow them to experience the benefits of all the advances we have made in medicine and science.

Q: What are some common trends you’ve observed related to men and their medical care?

A: Not always, but oftentimes they put the burden on their partner. When we ask them what medicine they take they’ll say “oh ask my wife, my mom, my friend, etc.” Those people then have to shoulder that burden, and I really want to change that dynamic. Men tend to focus on their longevity and independence; they want to still be able to do the things they like to do. So oftentimes I tell them, if you want to continue to be outdoors, to golf, to fish, etc., you’ll have to work with me. Men need to be more engaged in their own health and more proactive when it comes to visiting the doctor without others telling them to.

Q: What are some ways of reaching men that you think could be effective?

A: I think this is true for all patients, but especially true for men, where when I first meet them, my focus is mostly on building trust and building a relationship. It’s important to show them I'm on their side, rather than diving headfirst into medical details or trying to change how they view themselves or how they view their behaviors. Many men come to the health system and haven’t seen any sort of primary care, many of them distrust health systems, distrust medicine, distrust doctors.

With men, I often use a lot of sports metaphors. It’s silly, but a lot of men, myself included, love sports, and by focusing on that, I give them a sense of agency. I explain to them that we are both part of a team, and that we can’t do this without them, but that their actions will change the outcome of this game. I often position my patient as the quarterback with the medical team serving the offensive line protecting them. In the end, though, we can only create that optimal environment – it’s the quarterback who has to make the big throw.?