Choice is not the issue, especially in health care

Choice is surely the weasaliest word in the modern politician's lexicon. Has choice made our education system better? No. Has it met the pushier aspirations of the handful of middle-class marginal voters who decide elections in our first past the post electoral system? Yes.

I've argued before that when it comes to health care, choice is the reddest of herrings. Yes, the opportunity to register with whichever GP is more convenient makes sense, as health minister Andy Burnham outlined yesterday but if it is accompanied by league tables or some other ludicrous 'performance indicators', it will only increase the risk of a two or even three tier health care system.

If resources follow patients what will happen to the health outcomes of those left in the less popular practices? And in what parts of the city will those practices be, do you think? Let's talk Glasgow, as an example. Are these popular practices more likely to be in, say, Calton, a deprived part of Glasgow with a male life-expectancy of just 54 or in those parts of the same city where the life-expectancy is already 28 years longer? Come on, Mr Burnham, the clue's in the question.

So let's talk about what really matters in health care. More choice never made any sick patient feel better. Quality treatment does. And that should be available to everyone regardless of who their GP is.

The male mid-life crisis at midnight

My odyssey round the studios of the BBC continued yesterday when I was the guest on Richard Bacon’s great little late night show on Radio 5 Live. The subject was mid-life crisis.

Of course, the desire to hang around television centre at midnight getting excited about the prospect of seeing the guests on Later might be a sign of a mid-life crisis in itself but we’ll let that pass. The advantage of a programme going out live is that no editor will cut you for not saying the right thing as happened with the vasectomy programme I posted about yesterday. The disadvantage is that you come out thinking of all the things you should have said but didn't.

I was debating with a comedy writer from New York who thought that mid-life crisis didn’t exist. I said that the mountains of very similar emails from women to malehealth proved that it did. He argued that it was just an excuse for a lot of men to behave badly. Now I can’t disagree with that, but just as swine flu is an excuse for a lot of people to skive off work for a week doesn’t mean that many other people don’t have it and that, for a minority, it may be very serious.

Clearly there is something going on at the mid point in many men’s lives. (The French date it a bit more precisely than we do by calling it la crise de quarantaine – the crisis of the 40s.) Even if a lot of these guys are just swinging the lead or refusing to face up to responsibility, it’s still interesting to ask why. But, because of the argument about whether it existed or not, we never really got onto. My take on it is that, handled properly (ie. not denied), a mid-life crisis could be one of the best things that has ever happened to you because you’ll come out of it knowing yourself better.

I don’t believe you can make yourself happy – although you can make a major mid life mess if you don't understand this point – but you can be happy. And that involves being content and comfortable with who you really are – not who you or someone else would like you to be. In some men it takes a crisis - doing something stupid - to realise this. But I never quite managed to say this during the programme.

I must admit I still find going on the radio exciting and get really nervous beforehand even though I’ve done it a fair few times now. You get caught up in the roll of the show and don’t always manage to get your point over. So was it worth traipsing up to Shepherd’s Bush at the witching hour? You bet. The sight of Jeremy Paxman running out of the Newsnight studio closely followed by a fat man with a clipboard and the Archbishop of Canterbury is not something you see everyday. The perfect image for radio, it was funny to witness but probably even funnier in your mind’s eye. Next stop: Radio 4's Case Notes and online drugs.

Another kick in the nuts for men with PVP

Forget yesterday's post. Email from the lovely Dawn at BBC Scotland who interviewed me for the vasectomy programme:

'I've just seem your update on malehealth and thought I should email straight away. Unfortunately in the end I did not use you in the programme as my editor wanted it to be case study heavy and to feature the actual operation.' Great radio, Dawn but what will we learn?

Mark Williams is also on the cutting room floor. 'What my editor wanted in the end was a programme that represented the normal experience of a vasectomy.'

This editor does to seem to have understood that post-vasectomy pain (PVP) and poor erections are the normal experience of vasectomy for too many men. So this decision is a bit of a kick in the crutch for them really - rather like having another vasectomy.

The BBC, eh? No, I'm not going to join in the chorus of criticism. The reason this timidity has come as such a surprise to me is that it's so rare that the beeb miss the real story. Perhaps Dawn can persuade her editor to do a future programme on PVP.

'You’d never catch a urologist having a vasectomy'

Vasectomy continues to be one of the most popular topics on malehealth. I'll be talking about it on Radio Scotland at 11.30am on Wednesday 16 September 2009.

One malehealth reader Mark Williams will also be on the programme telling his story of ‘a continuous and sometimes excruciating pain’. He was told, amazingly: 'You’d never catch a urologist having a vasectomy'. Shame then that he'd already had the operation.

What's going on here? We are building up quite a file on vasectomy at malehealth. How come this supposedly routine operation seems to leave so many men in pain? And why are there no meaningful guidelines on the procedure from any of the Royal Colleges or the National Institute of Clinical Excellence?

It seems to me that the truth is as uncomfortable as a post-vasectomy patient. We'd all like vasectomy to be a pain-free and simple as described because, if it was, it would be ideal way to avoid unwanted pregnancy. Trouble is it doesn't work like that and a lot of doctor, health campaigners, men and women are struggling to accept that we may need to talk about the more complicated alternatives.

This online service is just what we've been waiting for

Ever since malehealth's Ask the Doctor feature closed down for lack of funding we've had dozens of emails a month from men wanting to ask a doctor a question online. Prostates, erection problems and premature ejaculation have been common topics.

Now, thanks to two pioneering new websites from the European Men's Health Forum (EMHF), men can at last get an answer to these questions in complete confidence without ever going near a GP's surgery or even talking on the phone - it's all online and all anonymous. The two sites are Your Prostate (www.yourprostate.eu) and Malehealth Questions (www.malehealthquestions.eu) which will deal with any aspects of ED and PE.

These are among the topics we are most frequently asked about on malehealth. There's lots of stuff out there on the internet all these issues but can you trust it? The EMHF is a trusted source. The MHF are members. Nobody will try to flog you anything and nothing goes on your medical records. There's no pressure and because it's by email, you go at your own speed at your own convenience at a time that suits.

Men have been asking for this for a long time and at last it's here. In fact, I was so impressed by what they were offering that I was happy to let the malehealth name be used. The service won't be available for ever so if you have a question on prostates, erection problems or premature ejaculation - and most men will have something to ask on at least one of these - now is your chance to ask.

Approach your problem side on

Here's an idea that may make it easier to talk about what's on your mind: Be active to the front and talk to the side.

By focussing on an activity in front of you, something arty, fixing the car, gardening or just doing the dishes will make it easier for you to discuss what’s on your mind with someone standing or sitting next to you. This will improve your mental health and may help improve other aspects of your relationship with that person too.

Good advice? Don't thank me, thank an anonymous malehealth reader. For our Men's Health Week competition, we were looking for an original and simple health tip. And this one leapt out at me - it works and yet I'd never heard it before. It was the best of nearly 1500 entries to the competition and many of them are equally simple yet effective. It proves what I've always believed: that good health is pretty simple and rarely requires major life changes. It also proves that you can never know it all and that there are always good ideas out there.

These two ideas are at the forefront of my mind as we redevelop the malehealth website. In the future it will be easier for you to share ideas with our readers. Watch this space for news of our redesign because we'll be looking for your views.

Meanwhile check out our Men's Health Week readers' tips plus our regular tips of the month section.

Latest Exercises for Scott Pearson's column

This month's videos from Scott (Sept 2009). Scott's column is here.

Incline/Wall Press Up:



Chair Squat



Box - or tricep - dips:



Bodyweight lunge: