Men’s health: more than throwing a pill

1 November 2010

web p BruceYarwood2Bruce Yarwood is a bloke and a practice nurse. If that combination is not rare enough, the practice he works in is dedicated to men’s health. Fiona Cassie finds out more about this army nurse manager turned men’s health specialist.

Sometimes it’s the wife that makes the call.
Men have come a long way, but phoning a men’s health centre is still a step too far for some.

Particularly if they want to book a vasectomy. Or discuss ‘men’s problems’ like prostate issues and erectile dysfunction.

But if they think they are just going to slip in, ask for an ‘as seen on TV’ prescription and slip out again – they soon find out more is involved.
The philosophy of Christchurch’s Menz Medical Centre – founded by GP Rob Williams to offer health services to men by men – is on primary prevention as well as cure.

And a 90-minute erectile dysfunction appointment will include a thorough ‘warrant of fitness’, with the tone of the first 30 minutes set by the dry Yorkshire humour of Bruce Yarwood.

Bruce will eventually make it clear that for many of them the best – and cheapest – long-term solution is not popping a pill but controlling their diabetes, blood pressure or simply losing weight.

Yarwood has been nursing for almost 50 years and a large chunk of that time has been spent in the masculine-dominated world of the army.
At the age of 15 – with his father a medical orderly during the war and an older sister a nurse – he decided to follow the family line and joined the British Army in 1962 to train as a registered nurse. His training was in military hospitals and his nine plus years in the British Army were during the Cold War and later during the Northern Ireland ‘Troubles’. He was working in a military hospital in Halle, Germany when he met his Kiwi wife-to-be Judy on her OE and the couple came to New Zealand in 1973.

After working at Christchurch Hospital as a nurse and tutor he returned to his army roots, firstly as a tutor training nursing officers and then as a senior nursing officer with a mixed clinical and management role in Burnham, Singapore and Papakura military camps.

On reaching retirement age at 45 Yarwood left the services and worked for a variety of nursing agencies before becoming the nurse manager at Christchurch’s 24 Hour Surgery in Bealey Ave. Then in 2003 he was asked by Rob Williams to be Menz Medical’s nurse.

After 23 years of nursing in the predominantly male British and New Zealand armies, the job seemed a good fit with Yarwood more experienced than most at nursing men. 

He says the centre’s patients are – apart from being obviously all male – largely ‘middle-aged to mature’ and tend towards the middle-class.

A few are enrolled patients but most have their own GP and come to the centre “for male specific issues rather than coughs and colds”. And they come from as far afield as Nelson and Invercargill. A major attraction is not having to muster the courage to discuss your erection problems while sharing your local GP’s waiting room with an elderly lady, your neighbour and her three lively kids.

In fact this is one of the few GP’s waiting rooms you will find without a toy box, no women’s gossip magazines and the TV is tuned to the History Channel or CNN.

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“The whole atmosphere is quite different to a normal GP’s practice – it’s certainly more male-focused.” The staff, from receptionists to the GP, nurse and practice manager, is all male. And as it is appointment-only – and most appointments are much longer than the standard GP 15 minute consultation – there is usually only one person in the waiting room at any one time. The result, says Yarwood, is men “just feel more comfortable”.

The lengthy appointments themselves are also an attraction, as they give time to work through a patient’s health history and problems even if the main reason they have sought out the centre is not brought up straight away. His work includes sexual health to vasectomy counseling, but much of it is carrying out – with a twist – the standard health assessment work of an experienced practice nurse.

His job in the warrant of fitness is to do the “preliminary stuff”, the patient’s details, weight, height, peak flow, urine test, blood pressure, etc followed by a thorough patient history and symptoms review before they move on to see the GP.

That the ‘warrant of fitness’ or annual medical assessment has ended up as the centre’s bread and butter work is for Yarwood an endorsement of the centre’s philosophy.

“It is encouraging – in terms of our philosophy – as it allows us to take a very pre-emptive role in prevention and detection of problems.”
So a client may come concerned about their prostate, erection problems or premature ejaculation but will leave having a good picture of their overall health and any general health issues that need to be addressed.

“As 80 per cent of erection difficulties have an underlying pathological basis,” says Yarwood. “It is a symptom rather than an end in itself.”
Once this connection is pointed out to men it can be a great motivator for working on managing other health issues like being overweight.
Which is good, as while the gap in life expectancy between New Zealand men and women has dropped from a peak of six years to four years in recent decades – let’s face it, that gap is still not good news for men.

Yarwood says men’s attitudes to health have changed since he began nursing, but very slowly.

“Men are in a constant state of denial,” says Yarwood. “They have this role they feel they have to play – to go and kill a mammoth or hunt a sabre-tooth tiger.” Worrying about your health just didn’t fit in and the vestiges of that “caveman” attitude were still around when Yarwood started nursing in the army. “Guys didn’t have problems until something dropped off and then suddenly they looked for help.”

Things have improved, with many men now viewing a ‘check-up’ in the same light as checking the oil and water of their car – but it’s always “just a check-up” and does not mean they have a problem.

Wives and partners are usually proactive in making their men seek help and Yarwood has been amused on occasion to find himself in a three-way phone conversation between himself, the wife and the behind-the-scenes husband.

Or men are spurred into action by health promotion campaigns like ‘Movember’ for prostate cancer. And for the record, Yarwood does support PSA blood tests as a diagnostic tool. “The reason for that is that we have found quite a number of prostate cancers – you can argue all you like about false positives, at the end of the day if we save guys’ lives, it negates the argument.” And if some prostate cancers are the kind you die “with” rather than “of” he believes you are still better off knowing, so you can make a decision about treatment rather than staying ignorant.

Being frank, open and not clouding the information with euphemisms is part of Yarwood’s style. After decades of working with men he has found that the direct approach is the best approach.

“If someone is overweight I will say ‘you are fat and if you don’t lose some of your fat you won’t live very long’ – it’s more in your face.”
But he also tempers it with a bit of humour, a comic arch to his eyebrows and his somewhat dry Yorkshire take on life. “I have been known to tell patients I think they are idiots if indeed they are,” he says. “Far better than dressing it up with innuendo.

“The guys seem to like it,” says Yarwood, then laughs. “Well they keep coming back, so it can’t be too far off the mark.” He doubts that a female nurse would get away with saying some of the things he does.

He is also up-front that he’s not a big fan of the direct-to-consumer advertising culture which promotes the idea of a fix-it pill as the only answer to impotency. “There are certain groups out there who are making a business of just selling PD5 inhibitors (viagra, cialis or levitra) and intracavernosal injections.”
Suitable patients may well leave Menz Medical with a prescription for one of the big three but will also be well aware of any underlying physiological causes – mostly conditions affecting circulation like diabetes, hypertension, obesity and sometimes side-effects of drugs like anti-depressants. “It’s identifying this rather than throwing a pill or putting a needle in it.”

“And some of these guys don’t actually need PD5s – they just needed their diabetes brought under control, or to lose weight and increase exercise… for a number that’s all they require.”

In fact making that link in men’s heads between getting an erection naturally and being healthy is a great motivator for change. “These guys value it (erections)… it’s a tangible aspect of their manhood at state.

“They may well need PD5s to help them along the way… but if you can convince them that to really deal with their erectile problem they need to resolve or control the underlying conditions… and they (PD5s) are expensive, so that’s another incentive to actually get off them.” Being healthier won’t see the problem fully go away for everybody, with natural ageing also making an impact, though this should not prevent older men from having a satisfying sex life.
In fact one of its oldest vasectomy clients was 70 and Yarwood says its clients have included widowed older men wanting to explore their gayness. “So its not just heterosexual masculinity, its really sexuality in general.”

It’s definitely not an average practice nurse’s job – not many have an anatomically correct model of a penis alongside a blood pressure cuff in their stock equipment – but it is a job this bloke thinks is more than worthwhile.