KEY MESSAGES
KEY MESSAGES
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| KEY MESSAGES |
· Under the Equality Act 2010, as a general practitioner (GP) you have a legal requirement to deliver services in such a way that they
do not result in direct or indirect discrimination against one sex or the other
· Men are more likely than women to die prematurely – 42% of men die before age 75 compared to 26% of women
· Men are 67% more likely than women to die from those cancers that are not specific to one sex or the other. Men are also 56% more
likely to develop those cancers and have poorer survival rates
· 76% of people who kill themselves are men
· Men’s mental and emotional health problems often emerge in different ways from women’s and are not always textbook cases; boys
are four times more likely to be diagnosed as having a behavioural, emotional or social difficulty
· 65% of men are overweight or obese compared with 58% of women, but most weight-loss services attract mostly women
· Men tend to have less healthy lifestyles than women; for example, men are more likely to drink alcohol to excess, more likely to
smoke, have a poorer diet, more sexually transmitted infections and higher HIV rates; they also take more illegal drugs and have
more accidents
· GP services are used 20% less by men than women; pharmacy services are used even less by men
CASE ILLUSTRATION
Gerald Hinks is a 58-year-old former warehouseman who lost his job 12 months ago when his company had to make cuts. He has been married for 33 years
and his two children have left home and live some distance away. His wife, Debbie, works part time in the local newsagent, which provides a very small
income on top of the benefits that Gerald receives.
Gerald hasn’t really consulted much with you in the past ten years as he has only attended once to have his pandemic flu jab, which he needed because his
elderly mother used to live with him until she unfortunately passed away four months ago.
You saw Debbie the other day in the local supermarket, when she mentioned to you that Gerald seemed quite tired recently and has been keeping her awake
by getting up at night two or three times. She has found it hard to get up at five am for her job owing to the broken sleep she is getting. She asks you what
might be wrong with Gerald. She also laughs out loud and says, 'And Doc, he can’t keep me pleased any more either – get him sorted out will you.' You
make your excuses and leave Debbie contemplating which bottle of wine she is going to buy.
The next week you see Gerald's name on your appointment list and welcome him to your consulting room but notice he has a slightly altered gait and that he
has gained weight. He tells you that in recent months he has been needing to urinate more and more during the night and this has led him to feel very tired
the day after. He also finds himself quite thirsty a lot of the time. He didn’t want to bother you but his wife had nagged him to come down. He has been
decorating the front room recently and found he had a dreadful case of back pain, which won’t go away with pain killers.
You discuss the issues with him, check his blood pressure and weight, ask about his smoking and alcohol intake, and advise him that you would like to
undertake a few tests to check out some of his symptoms. You find out that he is drinking two cans of strong lager each night, as well as three or four large
whiskies – to try and help him sleep.
You ask him if there is anything else worrying or bothering him but he denies this. You arrange to see him again in two weeks’ time. After Gerald leaves you
think about what he has told you and start typing into the computer the tests you need to order.
To help you understand how the GP curriculum can be applied to this case, ask yourself the following questions:
Primary care management
Who might I wish to refer Gerald on to for further care or assessment? How do I broach the subject of erectile
dysfunction with a man?
Person-centred care
How might I encourage Gerald to see me again for follow up? What if he isn’t too keen on coming back, now he
has seen me as requested by his wife? Do I feel I need to screen Gerald for any mental health issues? How might
I broach this with him?
Specific problem-solving skills
How do I handle the fact that I have already been given information about Gerald from Debbie? Should I involve
Debbie in the management of Gerald’s poor health, given that she spoke to me originally? Which, if any, of
Gerald’s symptoms particularly worry me?
A comprehensive approach
How would I tackle the issues Gerald presents with in the consultation? How and what would I prioritise?
Would I undertake health promotion in this consultation with him?
Community orientation
Why is it that men present less frequently to their GP – what factors should I take into account? What local
initiatives am I aware of that address the issues of men’s health? How might Gerald’s financial and employment
prospects affect his health?
A holistic approach What has happened in Gerald’s life that could have an impact on his health and in what ways? What social and
cultural issues could be at play here?
Contextual features If I deal with all these problems in the consultation and run late, what impact could this have?
Attitudinal features
What are my personal concerns about the use and abuse of alcohol that could influence my attitude to patients?
What are my personal preconceptions about men and the ‘male role’, and how might it influence my interaction
with Gerald? How and why might my experience of this consultation differ if this patient was female?
Scientific features
As a GP how will I ensure that I am up to date on the latest information on the management of two of Gerald’s
symptoms?
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