167: "It's Just a Cough": Men and Health Hesitancy

Scot: This is "Who Cares About Men's Health," bringing information, inspiration, and a different interpretation about men's health. My name is Scot. I bring the BS. The MD to my BS is urologist Dr. John Smith. You could say something here if you'd like to.

Dr. Smith: Okay. No, that's fine. Thanks for having me, Scot.

Scot: He's saving it for the topic, Mitch. And he's a "Who Cares About Men's Health" advocate, it's Mitch Sears.

Mitch: Hey there.

Scot: Today we want to revisit that notion why guys don't go to the doctor more often, especially when we really should. There's a big discrepancy between the health of men and women, and one of those major reasons is because guys just don't utilize healthcare the way they really should.

Even us, people that have been doing a podcast about caring about men's health and work in healthcare, sometimes don't go to the doctor when we probably should.

So a lot of times on this show, what we try to do is not only bring our personal experiences, but we also try to bring in some academic research to get other perspectives as well.

There was a paper on reasons why guys don't visit the doctor more often. Mitch sent it around to all of us. Dr. Smith, did you see that?

Dr. Smith: I read that paper, so I kind of prepared. And I don't love that paper, by the way. I mean, they took a bunch of kids from Weber State or Utah State that were in their 20s and 30s, and I can tell you what I thought in my 20s and 30s: I'm freaking Superman, dude. If I have an ache or a pain, I'm going to be fine, dude. I thought I was 25 until I was 40.

Scot: But here's the thing. The whole notion of this conversation is because of me. I should know better. I've been in healthcare for 10 years now. How long have we been doing this podcast talking about how guys need to take their health seriously, and you need to go to the doctor when you have issues? Don't be the guy that the wife has to nag, "Go see the doctor," and you're like, "I'm fine." And I still was that guy just weeks ago. I was that guy. How stubborn is that?

Dr. Smith: Well, then let's talk about it. I think that's a great one. It's like, dude, I can tell you right now, I didn't think I needed to go to the doctor. I mean, I still don't, and now I think I'm like 27.

Scot: Even though chronologically that's a lie.

Dr. Smith: Right, 100%. I mean, until I go to the basketball courts and try to play basketball with these kids, I still think I'm 27.

Scot: Do you still avoid the doctor?

Dr. Smith: Yes.

Scot: You're a doctor and you avoid the doctor?

Dr. Smith: Yeah. I don't like going to the doctor.

Scot: Well, what's your barrier?

Dr. Smith: I don't have time, man. Are you kidding me? I run a practice five days a week and I have to legit take a half a day to a full day off to go visit somebody to do what? For them to tell me what? You're fat? I already know that.

Scot: Sure. What if you were sick? What if you had some sort of illness and you were coughing pretty badly, sneezing, just not feeling good?

Dr. Smith: I mean, I'd have to feel real bad to go to the doctor. I'll tell you this. I busted up my wrist and it took me three weeks to go down to the urgent care that I work right above to get an X-Ray.

Scot: But at that point, is it urgent care?

Dr. Smith: It was not urgent. I mean, I needed care, but it wasn't urgent. I just wanted to make sure it wasn't broken, that if I was doing stuff, I wasn't really screwing myself over.

Scot: Got it. Mitch, how about you? Are you still avoiding the doctor, or are you pretty good about it?

Mitch: I didn't think I was until recently. My yearly checkup came up and I rescheduled it because I just was like, "I can't even this week. Not interested."

Scot: Why? What was your thing? Was it time or something else?

Mitch: Kind of stress levels. There was this part of my brain that was like, "I'm going to go and they're going to find something and that's going to be a whole thing. That's going to be a whole thing. And I'd rather not deal with a whole thing right now."

Scot: Sure. That makes sense. Mine happened over the holiday. I get this kind of bi-annual sick that I get where the first couple days I sneeze, and then that goes away. I never feel bad. I never get a fever. And then it kind of moves into my throat, I guess, because I will cough a lot and it can be a non-productive cough and I'll start to lose my voice. So I've just gotten to the point where I'm just like, "Ah, it's just the same as always."

This time, though, it lingered for three or four weeks, and finally my wife's like, "Will you go to the doctor?" And I was just, "Give me a couple more days and if it doesn't turn the corner, I will," because it's just the same old thing.

And during this period, I'm talking to other people. I heard other people got sick and I'm like, "Well, tell me about your symptoms. What's going on with you?"

Mitch: I was in one of the meetings where you did this, where you were asking all the things you probably should have talked to a doctor about, but to our poor social media manager who was like, "Yeah, no, they said I was sick."

Scot: But her story was a little different because she went and . . . Did they say she was sick? Were they able to do something for her?

Mitch: They were like, "Hey, yeah, just fluids and whatever." It was not a prescription or anything.

Scot: So anyway, I ended up going to the doctor because it didn't get better. And I tried to diagnose. I'm trying to figure out if like, "Oh, is what I have what other people are complaining about?" There are a lot of people complaining about this three-week, four-week-long thing, right?

Dr. Smith: Yeah.

Scot: So I go into the doctor and they do their thing, and turns out I have walking pneumonia. So there's that, right? I don't know. Would that have been a big deal, Dr. Smith, had I not had treatment for that? I mean, would it just have gone on forever? Was it life threatening? Was it just going to be unpleasant? Do you know anything about walking pneumonia?

Dr. Smith: Generally, it's an atypical pathogen, meaning that it's not the typical one that gets you for pneumonia. And generally they call it walking pneumonia for a reason, because you're still up and walking around.

Scot: Right. That's my point.

Dr. Smith:And so a lot of people probably have it and they never get checked for it, so they don't know they have it. So it's kind of that easy thing of like, "Did you have it or did you not have it?"

And if you don't get checked . . . It's kind of like the old, "You know how you don't get COVID? You just don't get checked." I mean, it's kind of that same thing.

Yeah, you can feel like crap for four or five weeks. Your body is probably going to get over it. The antibiotics that you're going to take for that four to five days are going to kick the bacterial load down and give your body a chance to get on top of it.

And so that's the main thing. You'd have been fine. You may have had lower oxygen saturations down in the low 90s rather than in the mid to high 90s, but it's not going to impact your overall longevity of life.

Scot: Okay. For somebody that's healthy, right? If you're older, then that's a different story. If you're younger, that's a different story I'd imagine, right?

Dr. Smith: But older people tend to then have more respiratory issues where they look like they're huffing and puffing and trying to blow houses down, and then they end up going to the urgent care or emergency department.

So healthy people that have walking pneumonia a lot of times can just walk around with it, right? Hence the name. And so people generally are going to get better.

Now, did that cause permanent scarring damage to a part of your lung or something? I mean, show me the literature.

Scot: Right. For me, I guess what it is, is I was constantly coughing. It was this dry cough. It was annoying to me. It was annoying to people. And I'm still sick, right? So I might be up walking around, still working, I don't have a fever, but it's exhausting. It's tiring.

Going in for treatment, did it actually shorten the duration, do you think?

Dr. Smith: I mean, generally that's why you treat it, is because you shorten the duration and you decrease the risk of long-term complications like scarring of the lungs, whatever.

Scot: Got it. So here's kind of the dumb thing. I find out I have this walking pneumonia, which, by the way, you tell that to people, it freaks them out. They think that you've got something major, but I'm like, "I feel fine." So here's the thing. I was struck by a couple notions. It's just men's psychology, and hopefully this will help guys maybe make a better decision more quickly.

Now, granted there was no long-term damage or anything like that, but I didn't feel great. It was kind of miserable. But if I was honest with myself, when I went in and they'd be like, "Well, are you short of breath?" and I'd be like, "No." And then I thought about it and I'm like, "Well, actually, I was." When I'd go out and walk the dog, it was harder to breathe than normal. And I guess I just assumed that that was the clogging of the throat, right?

So I think by writing it off as the same old thing that I always get, I overlooked that symptom and I overlooked a couple of other symptoms as well, because I think it was convenient to my narrative, if that makes sense.

If I was being honest with myself, I'd be like, "Eh, this is kind of like the same old thing, but there are a couple things that are a little different about it."

So why do we do that? First of all, why did I put it off so long? Well, I could tell you why I did it. I'm like, "Well, there's nothing they can do for me. It's probably just the same old thing I always get. It's a cold."

I think ultimately I went in because . . . And this was another interesting thing too. I tried to control the narrative when I was telling the doctor the symptoms. "Oh, this is just the same old thing I get. I get this and this, and here's what I want to do. I want to just try to figure out how I can control these . . ."

Mitch: You were backseat doctoring?

Scot: No. "So I can control these symptoms." And so my lesson learned there was just give them the symptoms. Give them the facts. Don't incorporate and encapsulate it into this narrative. Luckily, this individual was able to see through all that and didn't listen to me and did tests, right? I mean, they listened to me. You get what I'm saying though, right?

Dr. Smith: Oh, yeah. Well, the BS comes in, and you know when people are BSing you. You know when they've been on the Reddit forms trying to get testosterone. They come in and they're like, "Man, I've been at the gym. I haven't been able to make the gains I want to make. I just feel like I'm tired all the time. My wife says my libido is not what it used to be." And then you look at the wife and she's like, "What are you talking about?"

I mean, you can smell the BS on a lot of that stuff when you know people are trying to give you what they want to hear. And to a certain extent in our healthcare system, we allow that. When you go into the doctor, you can push a narrative to get what you want if you know what you're doing. And you're someone who's astute enough and smart enough to probably pull that off.

Scot: But it got in my way, because it was just like, "All I want to do is just control these symptoms," and I already basically was trying to tell this healthcare professional, "This is just the same old thing. There's no need to look at me." Why did I do that? That just seemed dumb.

Dr. Smith: Well, despite knowing that that person went to school to learn this, don't you feel like you're one of the smartest guys in the room when you go somewhere? I mean, just be honest.

Scot: Not necessarily, but about me and my body, I think maybe that was part of it. I've lived this life. I've gotten this before.

Dr. Smith: Yeah. And that's what I mean. You're drawing on the past experience where you're like, "I know what this is. I've done this before," and then you've got this doctor who's like, "Maybe we should check this out. It might be something more serious." You're like, "Dude, trust me. This is twice a year. I lose my voice. My voice comes back in two weeks. This is just a little bit longer. Maybe I was staying up a little later. It was the holidays. My family was in town." You're making excuses up, right? And you're like, "I'm fine," so of course you're going to control the narrative, man.

Scot: So one lesson learned from this experience is just tell the symptoms. Just tell the symptoms, and if they need to ask some background information, that's fine. But I was just really disgusted with myself that I couldn't . . . I want to get better. I want it to be something. Well, I don't necessarily want it to be something, but it was just strange, my behavior.

I mean, luckily for me, it was something that wasn't major. It was walking pneumonia. That's not going to have any long-term effects. But what if it is something that's more serious and you're still trying to do that instead of utilizing the expertise of that individual?

Dr. Smith: I mean, I see that stuff all the time though. In my clinic, these guys come in that are in their 50s, 60s, and 70s, and oftentimes they're with their spouse and they've just had a catheter put in or whatever. They come in and they're like, "Yeah, I didn't have any problems urinating before this catheter got put in." And I'm like, "You sure? Your flow wasn't any slower? You felt like you were emptying good? You're not waking up at night?" All the symptoms that would tell me that they have a problem. He's like, "Yeah, I wake up at night once in a while." And every time their spouse just looks at him like, "This dude's just high as a kite."

Scot: And what is it? Are we just not paying attention?

Dr. Smith: Well, I think we just don't take things seriously. I think the education level of most people is like, "How serious should I take this?" And if you ask all your buddies, you go golfing and you're like, "Hey, Bob, do you pee more than you used to?" and he's like, "Yeah." And so you just think, "Oh, it's just because me and Bob are old." And so I think some of that is we play on each other.

Also, no one likes to be told what to do, number one, no one likes to be wrong, number two, and we all know our body better than the guy that we're going to see, right?

I've lived with this body for 43 years. You've lived with your body for 29 years, and so you've got this presupposition of like, "Hey, dude, I kind of know my body better than you, dude. This is kind of my body. I don't know if you know this." And so I think that that plays a role.

Plus, guys in general don't like taking time to go to the doctor. Doctors are annoying. Let's get serious for a minute. I mean, there's a lot there that I can totally see these people going, "Eh, it's not that bad."

And the other thing is that's the other thing that gets you. "Eh, it's not that bad." How many times have you bought something at a restaurant and you're like, "Eh, it's not that bad"? We kind of just settle for that kind of stuff.

Scot: Right. So, in some instances, that's probably not the best play, huh?

Dr. Smith: I mean, I think in most instances it's not a good play. If you get that steak and you're like, "Eh, it's not that bad," when you could have had a steak that was cooked correctly and you would've really enjoyed your meal.

Think of it in terms of another avenue where you wouldn't put up with that, right? You go get your tires rotated and your car shakes a little bit. You're like, "Eh, it's not that bad." You're not going to put up with that. You're going to go back and be like, "Hey, Tommy, my car shakes when I drive it. You didn't do this right. Go do it right." And so we don't do that to ourselves because we're never wrong.

Mitch: I also wonder how much of it is . . . Because I know myself. I've also run into the "not wanting to bother the doctor," right? If this turns out to be nothing, man, oh man, I've wasted their time. And number two, it's almost like a DIY approach to my health on occasion, right?

Dr. Smith: TLC has completely ruined medicine.

Mitch: One hundred percent. In the past, I've been someone . . . I stub my toe all the time. I don't have a lot of body awareness. But I've broken multiple toes multiple times, and it's gotten to the point where it's just like, "Eh, I know how to fix this. I'll tape it to the next one."

I've listened to pieces and we've recorded pieces with ER docs about what they would do in the ER, when maybe there are some things that happen that maybe I shouldn't be trying to take care of myself.

Dr. Smith: And even in medicine, I mean, you see doctors that sometimes will be like, "Oh, I just prescribed myself an antibiotic because I feel okay." I have a rule that I don't treat myself. If I need something, I'm going to just go and get care.

But I also made that determination when I was a really young doctor in medical school, because I had some folks who I worked with that were like, "Hey, let me give you a piece of advice." And these were people that were mentors that I looked up to. They were like, "Never treat yourself, because you're always going to kind of look at it from your skewed perspective." And I'm not the pessimist, so I'm always going to look at it like, "Eh, it's not that bad," which most people probably do.

Scot: I think this would probably be a great time to end this podcast right there, that story, that notion that even doctors cannot look at themselves and symptoms that they have honestly and diagnose themselves. You really need to have that external point of view sometimes.

And I think, Mitch, maybe even what I was doing by saying all that is I was trying to make it that I wasn't bothering the doctor, right? Like, "Hey, I know that this is a normal thing I've got, I know there's nothing we can do about it, but I'm just looking for the best way to control these symptoms." That was my ask, right? And I think maybe that's what I was trying to do, was just to say, "Hey, I'm here for a purpose."

Dr. Smith: Well, and you're not wasting the doctor's time.

Scot: No, I know. Again, I know that, but . . .

Dr. Smith: Yeah. I mean, we still feel that, and there is that press of like, "Oh, doctors are busy, blah, blah, blah," but the other thing you've got to think about too is when you go somewhere, you paid for that movie ticket and you're not going to let the guy in front of you ruin the movie for you, right? I mean, you paid your money to be there. You might as well get your money's worth out of that copay.

I joke with patients all the time. I always say, "Hey, is there anything else you've got? Because we've got to get your copay's worth." At the end of the day, those are things where sometimes we do get into issues of things that may be a bother to them that we probably wouldn't have got to otherwise.

And you've got to realize going in, "Hey, man, I'm paying this copay. Let me get my money's worth out of it," rather than being a burden on the doctor. I feel like a lot of patients do feel that way, like, "I'm probably a burden on this doctor." Bring it up. That's what I'm here for.

And some doctors might have less time than others or whatever, but at the end of the day, that's the whole reason you're paying them. You're paying them for their expertise. You don't tile your own floor in your house, because you're going to pay somebody else that has the expertise to do that. You could probably DIY that too.

Mitch: When there's a specialist out there that can . . . Yeah.

Dr. Smith: And that guy could have done it in half the time, or a third of the time, and it would've looked way better, and you would've spent . . . I mean, if you look at your time as money, you would've been better off.

Scot: So the learning experiences from this whole thing for me was, one, just go. I mean, this thing went on. For four weeks, I was coughing. That was probably enough, wouldn't you say?

Dr. Smith: Absolutely.

Scot: So I just finally . . . And I'm like you, Dr. Smith. The time. Even though I was sick, I just didn't want to go. I didn't want to sit in a waiting room. They did the X-ray, they found out that I did have something that wasn't the normal thing, and they were able to give me some medication that hopefully shortened the duration of that, although it did kind of linger for a long time after that even. Still trying to deal with the cough, believe it or not.

Dr. Smith: Well, some of those things linger for a long time.

Scot: Yeah. The second thing is just the dishonesty with myself, me just default going to this narrative that this is the same old thing without actually even really considering other evidence that was right there in front of me until I was confronted on it and asked about it, and I'm like, "You know what? I have been short of breath lately. Yeah, I guess my chest has been tighter than what it normally is with this particular thing." It was just bizarre to me how blinded I could be by that.

And for me, it was just walking pneumonia. For somebody else, it might be a cold. But for other people, it could be more serious symptoms.

And then my need to go in and control the narrative and my need to tell a story as opposed to just saying, "Hey, here's what I'm experiencing right now. What do you think?"

Dr. Smith: I think that's human nature, though. I mean, I don't know what you guys think, but I think when you go in, you never want to show weakness. You never want to show the . . . It's like, "Ah, it's fine." And in reality you want to go and control that narrative because it's your body and you feel like you do want to have that opportunity to control it.

I don't know. I mean, I would probably do the same thing knowing how I operate. I would obviously want to make sure that they knew that, "Hey, I'm not an idiot."

Scot: Yeah, I think there's some ego involved for me too.

So what do you like for a patient as far as how they explain what their situation is? What is the most useful for you to help them? Is it just to simply say, "Hey, doc, here are my symptoms. I've been urinating more frequently at night, dah-dah-dah"? Just give them the facts? Is that what you're looking for? I mean, what are you looking for? How could somebody give that information to you in the best way?

Dr. Smith: Yeah, I think that works. And obviously, everybody is different. I mean, some people are more apt to be open to just show up at your office and be like, "Hey, my urination is not as what it used to be," or, "My erections are terrible," or whatever it is that they're there for. I see a lot of that. But I think just being open to having the conversation.

We've been trained as doctors to ask the right questions for that thing. So if you come in and you're having difficulty urinating, I'm going to ask you those questions. "Hey, Scot. Have you noticed your flow is slower than it used to be? Have you noticed that you go to the bathroom more frequently during the day? Are you waking up more at night? Are you noticing that you have more urgency or a need to get there quicker?" and those things.

We'll guide you down that path. We just need you to be honest with us in that narrative of . . . You can control the narrative. I don't even care. You can come to my office, and as long as you have some honesty, you can have your narrative. I don't care. I just want to know so that I can help you, right?

Scot: As a doctor, you can get through that. You can understand the difference.

Dr. Smith: Right.

Scot: The other thing that I do too is I was, I think, trying to diagnose myself.

Mitch: Oh, yeah.

Scot: I'm taking my symptoms and not only am I just presenting . . . I'm not even really presenting just that information. I kind of am, but I'm also then telling them what I think it means.

Mitch: Yeah, I sometimes worry . . .

Scot: Why am I doing that? Where's that gotten me so far?

Mitch: I don't know about you, Scot, but I sometimes worry that because I do work in healthcare communication, and because I do talk to doctors all the time, there's a part of me that assumes I know better than some people, right? I know what's going on.

Scot: Or just enough.

Dr. Smith: Well, I think we all do that.

Scot: I might say, "I'm coughing, but I think what that has to do with is I think it's this, this, and this." "Well, no, you don't know that, Scot. That's why you're here."

Dr. Smith: Well, I think the advent of all the technology that we have at our fingertips too . . . I mean, you can go find a medical journal of an article that came out in 2024 that I've never seen. And I don't mean that to be like, "Oh, doctors don't stay up on things."

Scot: There's so much.

Dr. Smith: The amount of stuff that's coming out and being published, for better or for worse, is there. I think it's great that people are interested in their health and they want to look these things up and have those conversations. But that also leads to a double-edged sword of some of those people will bring that information to your office and be like, "Hey, did you see this article in JAMA of the February issue where it talked about X, Y, or Z?" And you're like, "I haven't read that yet. It just came out on Thursday, but I'm glad you read it already."

And so it is great in that aspect, but then you have the other side of the coin where people go, "Oh, I read this article. I know what to do."

Scot: Right. And that article is such a small little component of the bigger picture, right?

Dr. Smith: Right.

Scot: And that can be dangerous because you have this little bit of information, but you don't have the context. You don't know how it fits into the bigger scope of information, and that's where that healthcare provider can actually help you with that.

Dr. Smith: Right. And that's where we look at comprehensively looking at things that hopefully we're looking into putting the picture together for you. But I think that's one of the dangerous sides that we see with all that. At the same time, I think that those are good and bad things depending on how they're utilized by the patients.

Scot: So what is the point of this particular episode, Mitch, for a listener?

Mitch: I mean, I'm introduced as the convert, and I do take my health a lot more seriously than I did before. I thought I was 29 until I started this podcast, right? But just the idea that all guys in one way or another, and I think all people period, will still have these kinds of hang-ups about seeing a doctor, going to a doctor, finding out if their discomfort, their condition, their symptoms is something actually worth going and getting treated . . .

Scot: Right. Having a conversation with your doctor, how we do that.

Mitch: Yes. And just this idea that . . . I love some of Dr. Smith's analogies. If your car is shaking, if your steering is a little out of whack, you're going to take it into the shop, right? If your body is a little out of whack, why don't we do that same approach?

Scot: Yeah. It's just as important, if not more important. Well, hopefully maybe you've witnessed some of your own weak spots. Maybe you've been putting off getting care for a particular reason and you're telling yourself a narrative, or you're like, "I just don't have time to do this," or whatever the reason. Maybe this will help you recognize that little weak spot that you have and help you get over that so you can seek care.

I think we had another doctor who was a mental health professional, but it was just like, "It doesn't have to be this hard." If it's hard, why does it have to be hard? It doesn't have to be hard.

Any final thoughts, Dr. Smith?

Dr. Smith: No, I think this is great. I think the biggest thing I would say is just sometimes it does take a little bit of swallowing your pride or your knowledge and ability. And personally, I would never disparage somebody for taking an active role in their health. I think it's awesome.

But I think sometimes saying, "Hey, let me just check in and make sure that I'm on the right page. This person got a mortgage on their brain to figure this stuff out, and so I might as well get some insight. It's only going to cost me $20 or $40 for this copay to really go in and ask my questions."

Asking those questions, you're going to get the answers that are going to benefit you long term. And I think it may require you to go back for a couple visits to really get to the bottom of some of these things possibly.

Again, you take your car into the mechanic because he's an expert in that field, to play on that old analogy. But I mean, most of us don't change our own oil. Most of us don't balance our own tires, all those things that we do that we're fine paying somebody for. But when it comes to our health, we're like, "You know what, dude? I've got Google, I've got the cell phone, I've got unlimited data. I'm just going to go ahead and look this up, and then hopefully it works out."

You go spend $150 to get your oil changed in your car, but you won't spend $40 to go and get the information that you can get about your health, which is really important.

Scot: Or try to save your marriage because you've been coughing for 40 days straight.

Dr. Smith: Right. Because your wife hasn't slept in a month and a half and she hates you now.

Scot: Yeah, spouses don't enjoy that. I don't blame them. They shouldn't.

All right. Well, thank you very much for letting us have this conversation with you, Dr. Smith. We sure appreciate having you on the show.

Do you have any insights of your health? Do you have any similar stories that you'd like to share with us? We would like to hear from you. You can email us hello@thescoperadio.com.

Thanks for listening. Thanks for caring about men's health.