When men dodge the doctor
For Ralph Dorsey, a referee and president of the Chester Biddy Basketball Association, the first sign of trouble came as he ran up and down the court. His feet hurt, but he told himself that real men don't complain about pain.
For Ralph Dorsey, a referee and president of the Chester Biddy Basketball Association, the first sign of trouble came as he ran up and down the court. His feet hurt, but he told himself that real men don't complain about pain.
When Dorsey finally made it to the doctor in 2008, he was first diagnosed with athlete's foot. But within a month, his foot turned dark and the verdict was far more serious: gangrene caused by blood clots in his veins from peripheral artery disease (PAD), a circulation disorder often associated with poorly controlled diabetes. Three toes had to be amputated in an emergency operation.
Dorsey tried to go back to life as usual, which for him did not include worrying about his health. Though he was told at first that he had diabetes, he later was told he did not. He missed appointments to check the dosage of his blood thinner medication. He kept on smoking.
By 2013, he had to have his right leg amputated below the knee.
At last, he woke up.
"I have male and female friends who say, 'Man, you stay at the doctor's,' because now I do go," said Dorsey. "They aren't used to seeing men go to the doctor."
"I didn't go to the doctor because I didn't have problems," Dorsey said. "I was a healthy man. I smoked, but I didn't do drugs or alcohol."
Numerous research studies have borne out what many anxious women know: Men don't like going to the doctor. And, experts say, that's especially the case for black men such as Dorsey.
The result can be seen in what has happened with amputations for circulatory disorders, frequently but not always related to diabetes. They so frequently can be prevented if symptoms are addressed early that they are widely seen as a marker for effective preventive care.
From 2012 to 2014, the numbers of major amputations for black men in the Delaware Valley jumped from 209 to 252 a year, while numbers for black women dropped from 155 to 133.
What accounts for the discrepancy?
"Women are often the medical caretakers for their families," said Eric Choi, chief of vascular surgery at Temple Health. "And because they go to the doctor, they may benefit from advances in arterial reconstruction, foot care and diabetic wound care."
Another possibility is that "black men tend to be more distrustful of the medical system and don't go to the doctor as much as black women, and that older black men, in particular, have more reservations about going to doctors," said Ronald Renzi, an Abington podiatrist. He is the director of Save Your Soles, a grassroots organization that educates black men about diabetes care to prevent amputations.
Diabetes, which can lead to neuropathy or nerve damage, slow healing of wounds and PAD, among many other problems, is endemic in the black community. People of any race struggling to make a living face a greater risk of poor diets, lack of time and resources to exercise, and difficulty accessing medical care. All of these factors are more pronounced in minority communities.
Comparing Philadelphia with its suburbs, the rate of amputations is now 2.3 to 1 - an improvement over recent years, but a striking difference, nonetheless.
"Everyone knows someone who has had an amputation, compared with white communities," said Choi. "It's a very scary proposition."
Kwasi Kwaadu, a podiatrist at Temple Health, said there are many reasons that some people avoid doctors.
"We live in a country where we have different kinds of family dynamics. There is a scenario where a patient has a legitimate medical issue that they know they need to address, but because of socio-economic factors they don't.
"As the head of a household, a male may defer their care to other things that they may find more important. Or they may have trouble getting to the doctors or be financially unable to pay for care," he said. "Financial problems are a frustrating thing we see in our practice. We try to exhaust all our options in supplemental aid, but it's a problem."
Dorsey, who now works as an outreach specialist for the City of Chester Health Department, agrees.
"I had health insurance, but I was putting things before my pain," he said. "I told myself I have to get to work, I got to get to the basketball league, I got to go to my son's school."
Education, reassurance and persistence can pay off, said Choi.
"When we identify a patient at risk we tend to be much more aggressive. It it's an African American man in the 40-to-49-year-old age group, we do follow-up calls, make certain that they can find time to see us, and try to find a time that is more convenient for them," he said.
One area all of the doctors thought could be improved is disease management programs sponsored by insurance companies, which often offer "one size fits all" advice for diabetic limb care.
"Companies haven't targeted areas where it's a particular problem," said Renzi. "In certain Philadelphia zip codes, where there are huge amputation rates, patients might need foot check-ups three times a year, rather than one."
Said Choi: "Whatever we're doing now is not working for African American men. We need to be more vigilant."
Dorsey, who volunteers for Save Your Soles, is adamant about changing behavior in his community.
"Anyway I can help somebody to keep their limbs in place, I'm going to do it," said Dorsey. "We're going to spread information if we have to go door to door."
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