‘Men will talk as long as women will talk, they will break into tears when it’s getting to them if we start the engagement and this is the whole crux of the difference with men’s health,” says Victorian men’s health nurse practitioner Peter Strange.
The Men’s Health Clinic at Bendigo Community Health Services has been nationally recognised for its model of care in men’s health provision and its engagement of men with health services.
Men’s health is arguably a specialist area where services need to be oriented to men where they feel comfortable and have that engagement, says Mr Strange.
“The biggest insight I have in having done this for 10 years is that men will hang on to an issue for three to five years; they need to talk to someone but we need to reorient our services to engage them.”
Strange was one of the first endorsed nurse practitioners in 2002, passionate about men’s health he advocated for a service in Bendigo.
“There were not enough GPs in the area so we got a clinic up and developed a model of care for men’s health and started the men’s health clinic that was male friendly.
“We provide a professional service as best we can for men in our area and the issues we commonly see.”
The men’s health clinic is a male-friendly welcoming place to engage men, including a waiting room with footy jumpers on the wall, posters of gay men, and model boats.
“Work is really important to men. Getting them in for prevention they were just saying ‘I haven’t got time, I will have to give up work to go’. So we set up an after-hours clinic every Tuesday to run until 8pm; a GP swapped to an afternoon shift.”
It’s not just about posters or having footy jumpers in the waiting room to foster engagement. While it’s important to make services male-friendly, the other thing is to ask men questions directly and provide the time, says Mr Strange.
“Two health topics are really hard for men – mental health and sexual health. Six minute consultations are unfortunately very prevalent with bulk-billing and GPs do not have time to ask men how they are feeling. If they’ve waited 25-40 minutes and they get six minutes they are unlikely to bring up something that’s worrying them.”
“With the clinic, I run 30 and 45 minute consultations. We bring up the topics that are hard to discuss. I ask about erectile dysfunction. I ask them ‘how are you going mate, how’s it going downstairs?’ ‘Do you have any problems having an erection?’ and ‘how are you travelling? Do you get depressed or anxious?’”
There needs to be recognition that men are late presenters for health problems until it gets critical, says Strange.
“They will try to deal with it themselves even chest pain. I will say, ‘Do you get chest pain? Do you get short of breath?’
“They will say, ‘Nah, not really’ and they have been having angina for six months. We need to engage earlier and better.”
Primary healthcare nurses should use every opportunity to engage with men about their health, urges Mr Strange.
“Engage men, even if they come in with a sore knee ask them about other important issues. If you get an opportunity ‘How are you going? While you are here can I do your blood pressure and a few other tests?’”
Health promotion, particularly in the early days of the clinic was key to uptake of the service by men. Peter provides health education to the community, including to men’s sheds, business groups and tradies.
He also runs a three hour clinic at TAFE every Wednesday where men travel from up to 100km away. The men named it ‘The Shed’ themselves rather than the men’s health clinic. Thirty minute appointments with the NP are available where men are called out of the classroom for that period. Confidentiality is paramount, says Mr Strange.
“It’s really important to these young guys and it’s orienting those services to what they need and what they will respond to. It might be chlamydia or to talk about stress, drug and alcohol issues or a physical health complaint.
“They may not be getting enough sleep and using drugs and alcohol and then that gets out of control and they’re worried they will lose their job. They might have anxiety and depression.”
Mr Strange says his workload constitutes one third annual check-ups, one third sexual health and one third mental health.
“We are trying to be a service that provides expertise in men’s health. We are not seeing patients that GPs are seeing and doing well – we don’t see sore throats or appendicitis. We are doing the hard stuff that other people do not want to or are unable to do.”
Despite a white paper in 2010 for a men’s health strategy, there needs to be government funding specific for men’s health, not just diseases such as prostate cancer, argues Mr Strange.
“We need a push for men’s health services that are appropriate for men, to be able to move that big mountain for men to access healthcare earlier.”
Looking to retire in the near future, Mr Strange wants sustainability for the men’s health clinic in Bendigo.
“I want to keep this passion of mine for men’s health going. I need a young person to come in interested in being a NP and in men’s health. If you have a genuine interest in men’s health and in providing a men’s health model of care in Bendigo, get in contact.”
The Movember Foundation, the leading charity changing the face of men’s health, is urging Australians to sign up to a challenge this November for men’s health month.
There are three ways to get involved and support men’s health in Movember 2019: to ‘Grow a Mo, save a Bro’; walk or run a total of 60kms; or host a ‘Mo-ment’ and help raise funds.