Communication

As a health professional there are two singularities when working with men that amuse and concern me. The first is their ability to understand all the good health messages (exercise, nutrition, sleep, etc) and the risks associated with non-compliance yet continue to engage in a fierce campaign of non-compliance. The second is their concept of what exactly comprises being healthy.

Taking the second one first, it seems to me that for a bloke, being healthy is simply the absence of death. As long as he can function in his life to some degree he sees himself as ‘in good health’. As demonstrated by the first response to the standard clinical interview question, ‘and how is your general health?’, to which he inevitably replies, ‘pretty good’. Only to reveal later (once rapport and confidence have been established) that he has type II diabetes, high blood pressure, sleep apnoea, two coronary bypasses, kidney disease and an unexplained tremor on movement. None of which have anything to do with health in his mind because he is still walking, breathing and working. The message for us is – don’t believe him! Dig deeper on health matters and try to get him to see how his current state is the end-game of his lifestyle decisions.

Back to the first issue on non-compliance. This is a second defense mechanism deployed by his male ego filter which may acknowledge at a cognitive level the links between lifestyle decisions and the prevalence of non-communicable diseases but seeks comfort in the fact that this only applies to other men. Every bloke believes he is outlying data – the exception, the maverick, the hero. Compliance is for those other men who are at risk, and as ‘I am not at risk I have no need to change my attitudes, thoughts and behaviours’. This is the blank canvas upon which we try to paint a treatment plan. Until the man acknowledges his risk he is not able to make vital changes. Note: acknowledges risk, not just understands it. Sometimes our job may include scaring the invincibility out of them to over-ride the ego filter defense. For example you could try this, ‘I had another client like you who did well for a while then it all went belly-up and his stroke left him totally disabled. If only he had done the exercises…….’. This line is best delivered while gazing into the distance over the client’s shoulder and gently shaking your head. Then pause, and make eye contact until he looks away.