 And joining us now to talk about your health is Dr. Joshua Starr, primary care provider, University of Maryland Baltimore Washington Medical Center. Dr. thank you so much for joining us. It is men's health month. So at the outset here, give us a couple of things that you want all men to be thinking about. Thank you. Thank you for having me, Jeff. It's a pleasure to be here today and share some basic information with your viewers and listeners. I think first and foremost, having a doctor on a regular basis is I think an important thing for men and anyone in general as they get older, but particularly men for whatever reason we have a tendency to avoid doctors. And I think that we have a tendency to self-diagnose like a lot of people. So I think having a medical doctor to bounce some ideas off of, ask questions and follow up on a regular basis is a really good idea in my opinion. Some other basic things I think that are important as well. Regular physical activity, we gotta move. We spend too much time sitting and we all have I think far too sedentary jobs. So movement is something that I really try to talk to my patients about. Some is better than none. Any type of movement is better than no movement. So I think movement in general is really good. And then the last thing I think is really important as well is just make our own food as much as possible. Cook at home whenever you can, buy whole ingredients, try to stay away from the processed stuff. I think those are pretty basic things that hopefully a lot of people can do on a regular basis. A lot of things we can dig into there. Let's start with the idea that men, more than women, tend to avoid going to the doctor. Is it because it costs money? Is it because sometimes it's invasive, it may hurt? Is it a masculinity thing? Why do we do that? I think it's like a lot of things in life, multifactorial, right? I think it depends on the individual, it depends on where they're from, depends what culture they grew up in, it depends on their family unit, personal experiences that they've had, how they tend to cope with stressful situations. I believe there was a study looking at Hispanic adults by the Pew Research Group recently that showed that about 50% found it challenging to find a doctor, found the whole process of trying to find a medical professional to be daunting. So I think culture plays a role. As I said, I think coping mechanisms, we all, not we all, but I think a lot of people tend to use avoidance as a coping mechanism, whether that's because of a personal experience they had with a doctor, or the medical system, or a family member's personal experience with the medical system, or they're just afraid, or they're in denial of some sort of symptom and they'd rather not address it and they'd rather just avoid it. I think that time plays a huge role as well. I'm a parent, I'm a husband, I work full-time and time is at a premium, so it is very challenging to carve out some space in my day, or I make it seem like it's more challenging than it is. I think we have to put a priority on our health. So far too often, it's just not a priority. You mentioned the importance of actually having a doctor. Primary care has changed a lot. I mean, it's become a little bit more of a factor. You're seeing a lot more physicians, assistants, nurse practitioners. You're a young doctor. You chose family medicine in medical school. Why did you do that? There's several answers to that question, I think. One is that it's incredibly varied. I don't like doing the same thing every day. I like some variety in my life, so I think doing the same thing for an entire workday, for an entire week for the rest of my life would just bore me to death. So family medicine definitely has that variety, which I enjoy. I also think that there's a personal touch, I think, that I try to give in my practice as well, just having conversations with people, getting to know people, developing a rapport that I don't think you can get in certain specialties, let's say. It's not to say that you can't get them, but just for me, family medicine just spoke to me for those reasons. Yeah, and I don't mean to diminish the importance of nurse practitioners, they're hugely important. And probably, if you've got a strep throat or something, they've probably seen more of it than anybody else, right? But the importance of having, maybe it's not gonna be an individual these days. Maybe it's gonna be a practice that you can become a patient of and you get to know the people at the front desk. And that gets you on the path to greater, health, greater medical care. You know, I trained in Illinois, I actually grew up in Canada, I practiced medicine in Canada, I had my own practice for a handful of years before I ultimately moved back to the area to be closer to my wife's family and help raise our children and everything. So I've seen both sides of healthcare. I would agree in some respects, it does seem a little more like a factory, as you said, maybe a little depersonalized at times. I think EMRs and information sharing certainly helps doctors who are maybe not your primary care doctor, but work at the same office, access to your medical information and get to know you a little bit. So there is a little bit of a history there, but I would agree with some of those things that it is a little bit of a challenge. Members of minority groups, clearly, frequently, study after study, have worse outcomes, are more susceptible to some common problems. In your practice, do you see that? What factors can you think about there and how should we address those disparities? Well, that's probably a little bit more than just a medical question. I think there's a number of different factors that lead to some of the disparities across cultures in the United States and in other countries as well. Again, I think some of them are particular to certain ethnic backgrounds. Hispanics, for instance, they have a culture that tends to be a little more, we keep some of our medical information to ourselves, we don't tend to go see a doctor. Certainly there are some individual cultural differences amongst groups. I also think that there is, again, I think you like to see people in general, at least I see a lot of people in my practice that like to see me because I'm young because when I tend to see a lot of young men because they want a doctor that looks like them, that is experiencing maybe some of the same medical problems as them or life challenges as them. So I think in part maybe there aren't enough doctors that have certain backgrounds that maybe somebody can relate to. So I think that that plays a role as well. And then there's a number of other factors I think that go beyond I think just the medical side of things that I think that can play a role for sure. Do you find that men come in and talk about a symptom and it didn't start yesterday, it started nine months ago and they're just now either getting up the courage or finding the time to confront it? Is there any other way that men present with symptoms? I feel like that is the main way that men come in with symptoms. I commonly hear this and I've experienced this myself in my own personal life. If that symptoms there next month or next week, maybe when I have a little more time or I think it's worse, I'll go see the doctor. And that's all too common, I agree. I think it's all too common for men in their 30s and 40s and sometimes even 50s to come in and see me and say I've never had a primary care doctor in my life before. So you wonder how can somebody's partner, family member encourage somebody, maybe they know there's a symptom, maybe they don't, but they know this person has never seen a doctor. They have no idea what the blood pressure might be, what other issues might be lurking. I'm wondering what you could say that would have a positive impact and wouldn't backfire because guys, we don't really like being told what to do either. Yeah, right, yeah, you can run the danger of being a little pushy. Well, I think that continuing to, I mean, it's a fine line for sure. You don't wanna be annoying. You don't wanna be bothering the person, but I think at the same time, it's important to make sure that they understand that health should be a priority, that there are conditions that exist that may not have any symptoms. One that comes to mind that I deal with all the time is high blood pressure. I try to explain to people that you're probably not going to know that your blood pressure is too high or too low unless it's through the roof and sky high or in the toilet, inversely and incredibly low. So that leaves a lot of variability in between and I mean, I think there's a reason why. It is a silent disease in a lot of cases because you're not gonna know if it's high or low or affecting any of your organ systems or anything like that. All right, let's boil this down a little bit for maybe three categories, just maybe too broad, but young guys, middle-aged guys, older guys, what screenings, what basic checkup stuff would be reasonable in those categories? Again, I'll say that it should be individualized based on, you know, age and demographics and, you know, backgrounds and family history. I think for young men, it's important just to kind of get your foot in the door and establish with a primary care doctor. You know, I think a lot of people come in and it's, again, maybe the last arts that they saw was their pediatrician because their parents were setting up the appointments for them. So I think when you're young and you're 20s and 30s, it's important just to get established with a primary care doctor and just come in for a checkup. Talk to them about maybe some small things that might be on your mind, maybe you don't think are necessarily concerning, but let the doctor be the judge. I think I try to err on the side of caution and just tell patients, listen, I would rather you come in with a silly question to talk to me for a few minutes, then let it go and months down the road or years down the road, it turns into a big issue because you never mentioned anything in the first place. So I think just getting your foot in the door is important. I think as you get older into middle age, some health screenings that are important can be things like colon cancer screening. I think that would probably be my number one thing because it's a top three cancer in the United States and we have very good screening tools for assessing whether or not somebody is at risk or has developed early stages of colon cancer. So that one definitely typically starts at the age of 45, it used to be 50, and we have traditional screening tools such as a colonoscopy. And we also have a little newer screening tools such as a colicard testing or fit testing that can be done a little less than basically from the comfort of your own home. I would say that some other types of screenings can be things such as prostate cancer screening for the right individual. We know that rates are higher in African-American men and we also know that rates are higher in people that have a family history of prostate cancer. I think that if you're a smoker, you can certainly talk to your doctor about lung cancer screening, which is a newer screening tool that we have for certain individuals who have smoked for a period of time. I also think that skin cancer screening is a useful thing as well, depending on the individual. Again, I think we do most of our damage to our skin, most damage to our bodies, to be perfectly honest, at a young age before we know any better. But I think that that follows suit with skin cancer screening as well. I think one thing I wanted to mention and should note with regards to screening tests is that screening tests are by nature for people who have no symptoms. Screening tests are not investigative. If you were to come into your doctor and say, I'm having chest pain or shortness of breath and we were to run a test on your heart, that would no longer necessarily be considered a screening test, that's more of a diagnostic test. So I think certain symptoms should definitely be mentioned to your doctor as well, things like as I mentioned, chest pain, shortness of breath, changes to your energy level, fatigue, changes to your weight, especially if they're unexplained and you've made no changes to your exercise routine or your dietary habits, changes to your urinary habits as well, I think especially as you get older. But again, I really just wanna emphasize the importance of regularly touching base with your doctor, I think that that's an important screening tool in and of itself. Dr. Joshua Starr joining us from the University of Maryland, Baltimore Washington Medical Center. Doctor, thank you very much. Thank you very much. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.