Patient's response to the research

BMJ 2003; 326 doi: (Published 12 June 2003) Cite this as: BMJ 2003;326:1313
  1. David Wilkins (david.wilkins{at}, policy officer1
  1. 1 Men's Health Forum, London WC1H 9HR

    Since “personal care” is ostensibly at the heart of primary care provision, it seems extraordinary that the concept remains—as the authors here rightly say—little studied. This research suggests that there is some important common ground between patients and healthcare providers but that perceptions nevertheless differ according to viewpoint. One of the more obvious factors that might have a bearing on the nature of the experience for patient and professional alike is the gender of the participants in that experience. Bald statistics tell us that men are significantly less likely to visit their GP than women, and anecdotal evidence suggests that they are rather more likely to present at a later stage in the development of disease. It seems likely that this state of affairs contributes to the continuing poor state of male health. Beyond speculation, however, we know next to nothing about why this should be.

    Much of what we learn from this study has the ring of truth in the light of what we have learned at the Men's Health Forum about men's expectations, attitudes, and behaviour. Responses to men's needs in primary care have in the past often centred on structural issues. Access may remain a problem for men in full time work, for example—though whether solving access problems is a significant contribution to making care more “personal,” as suggested by some of the GPs here, is a point that might bear further examination.

    Our experience suggests that a rooted reluctance to accept personal vulnerability may disturb the balance of good judgment for many men. It should go without saying, too, that unhelpful presumptions about how the sexes might, or should, respond to illness and injury are unlikely to be the sole prerogative of patients. The assertion here that “embarrassing problems” may lead to a preference for a service provided outside an established personal relationship directs us gently towards some extremely interesting questions about the nature of the relationship between professional and patient. Embarrassment is not the only form of personal exposure that patients must allow themselves to suffer. Do we currently know how to create environments that allow men to be comfortable in expressing their fears and concerns?

    There is much in this study that is useful (not least, incidentally, its accessible and readable style). More sensitive service provision is by no means the only route to the improvement of male health, but it is an important one. Any work that enhances our understanding of good primary care has the potential to benefit men. For those interested in the impact of male gender on health, though, the central questions remain largely unasked and certainly unanswered.


    • David Wilkins, policy officer with the Men's Health Forum (, responds to “He treats you as a person not just a number”

    • Competing interests None declared.

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