BOYS DON'T CRY SURE, THEY ARE PROUD - BUT EVEN WITH THEIR HEALTH AT RISK, MEN STILL AVOID THE DOCTOR.

Byline: Evan Henerson Staff Writer

``Nothing hurts, so obviously nothing's wrong.''

``Too many other things to worry about.''

``Hey, I work out. What more do you want?''

Fess up, fellas. How many of you have used one of the these replies the last time your wife/girlfriend scheduled - like clockwork - her annual gynecological visit and asked you, ``By the way, when was the last time you saw a doctor?''?

How about, ``No sweat, everybody in my family lives to be 100,'' ``I don't even know my doctor's name'' or ``I'll be !@#$ before I let a HMO get their slimy paws on me''?

All are common excuses. All, researchers claim, are distinctly male ways of thinking about wellness and health care. And all are ways so many men keep themselves out of doctor's offices until something is bleeding or broken.

A survey published earlier this year by the Commonwealth Fund, a private foundation supporting independent research on health and social issues, determined that ``men's irregular connection to the health care system'' meant they regularly go without preventative medicine - and not just younger men. Sixty percent of men over 50 had not been screened for colon cancer and 41 percent had not been tested for prostate cancer in the year prior to the survey.

When asked how quickly they would seek medical attention if they were sick or in pain, 24 percent of the men surveyed said they would wait ``as long as possible.'' An additional 39 percent said they would ``wait a few days,'' while only 18 percent said they would seek care as soon as possible. The data would be startling were it not so predictable.

``The survey did confirm what a lot of people believed in their guts from their own personal experience - that husbands, fathers and brothers were reluctant and that we really have to egg them on to seek medical care,'' says David Sandman, senior program officer at the Commonwealth Fund and the study's lead author. ``But we were surprised at the magnitude of the problem, at the percentage of people who had no contact at all with physicians.''

Another study conducted by the National Men's Health Initiative showed that in 1997 women visited the doctor 67 percent more often than men. A survey of men and women, age 18 and over, at more than 10,000 households in Pennsylvania showed that almost 25 percent of the men in the survey had not visited a doctor's office in the past year, compared to 14.5 percent of women. The survey, conducted by the Philadelphia Health Management Corp., also showed that men are less likely to have health insurance or a regular doctor.

Both doctors and survey researchers insist the male tendency to avoid doctors isn't necessarily prompted by exposure to unpleasant tests or fear of what those tests might reveal - although both can be factors. Personal health - and preventative medicine specifically - simply isn't something most men spend much time thinking about.

``And they get away with it,'' says Dr. Bruce Bagley, president of the American Academy of Family Physicians. ``Most men between the age of 20 and 35 have very few health problems. So there's no reason to go in. There is no literature to show that men of that age should go see a doctor every year. But that doesn't mean they shouldn't get health advice, eat properly and watch their weight.''

Part of their behavior is based on the luck of the biological draw. During childbearing years when women are most likely to see doctors on a regular basis, men of the same age are often walking around convinced they are immortal. It's not until he reaches the age of 50 that a man develops a greater risk of contracting a potentially life-threatening condition like prostate cancer or heart disease. And, not surprisingly, the older men get, the smaller the gap between male visits to physicians and female visits.

Then there's the effect of socialized gender roles, which, psychologists and sociologists say, discourage men from admitting weakness or giving up control. The ``boys don't cry'' ethic drummed into adolescent boys can translate to ``I just need a day of rest to kick this'' in adults. The impulse is the same: The man is conditioned to take care of himself rather than ask for help - particularly when asking for help means dropping your pants.

``Women are much more receptive in nature, and surrender isn't as much as an issue,'' says Sheri Meyers Gantman, a Tarzana-based marriage and family therapist who hosts a cable TV program called ``Straight From the Heart.'' ``Women can go to the doctor and receive knowledge and healing information. For men, it's like asking directions. It's harder for them.''

Consequently, health and wellness often become women's domain, with wives often scheduling both their own doctor's appointments and their husbands', say researchers at the Commonwealth Fund and the Philadelphia Health Management Corp. Longer, more consistent interaction with the health care system means women are more likely to have an established acquaintance with their doctors and are more able to ask questions during medical visits.

It often takes a crisis to significantly alter a man's health-seeking pattern. A parent or close friend's illness or death can go a long way toward getting a man to see his physician to make sure everything checks out. The same event can cause instant behavior change, like quitting smoking or resolving to lose weight. Conversely, a happy event, such as marriage or the birth of a child, can also serve as a wakeup call to a man that he needs to pay closer attention to his health.

But men's health advocates say health-related wakeup calls shouldn't come only from circumstance. The medical community and non-profit organizations need to aggressively start targeting awareness of the importance of screening for the types of diseases that afflict men. Survey researchers also say doctors need to find ways to improve communication with their male patients.

``I don't think it's a one-shot approach,'' says Dr. Lynne Kotranski, vice president for research and evaluation at Philadelphia Health Management Corp. ``Just for an example, a number of managed care organizations have reminder cards to women about when they're due for a mammogram. I don't know if the same thing is done for men when they should start getting prostate exams, or reminders to do self-examination for testicular cancer, which is usually a younger man's disease.''

``There are all sorts of tricks we try,'' says Dr. Richard David, urologist and chief of staff at Sherman Oaks Hospital. ``We'll make them fill out a postcard, mail it out and then chase them. We know we have to call most of our patients one to three days before the appointment to remind them.''

Citing the success of breast cancer awareness campaigns, David says women are more likely to stay on top of health issues - even male health issues.

``It's almost as if we should be targeting these things to women,'' he says. ``Usually you see the woman leading the guy by the nose saying, 'Go get your prostate checked.' ''

CAPTION(S):

drawing, photo, chart

Drawing:

(cover -- color) REAL MEN DON'T GET SICK

Why guys don't go to the doctor for regular checkups

Gregg Miller/Staff Artist

Photo:

This photo illustration demonstrates one of the prime physical health factors most men need to know and monitor: their blood pressure.

David Crane/Staff Photographer

Chart: TOUGHING IT OUT

Studies show men are unlikely to visit a doctor until they are very ill or in pain.