At my office, while seeing patients, I have noticed an interesting phenomenon. I define it as the “Men’s 3 D’s Problem.” The three D’s stand for every man’s three undeniable attributes: Denies, Declines, and Doesn’t Listen.

To demonstrate, here is what happened during a recent office visit with Stephen and Stephanie. Stephen is a new patient. Stephanie is his wife of 25 years.

I ask Stephen about his bladder symptoms and a split second later, Stephanie chimes in: “His stream is slow! Very slow!”

I ask him if this is true. He shakes his head, saying “Maybe a little slow, doctor, but, in all honesty, I’m fine.”

Looking for evidence, I put on my detective hat. I ask Stephanie, “How do you know that his stream is slow?” She responds without hesitation, “Oh, that’s easy, I listen carefully and I hear him peeing! Drip! Drip! Drip! One drop at a time,” she says, dramatically tapping her finger on the desk to demonstrate the rhythm of the dripping. It’s a drizzle, I conclude, not a storm.

At that moment, I realize that Stephanie is reliable and convincing. And I check the box next to “Denial.” With such poor urinary flow, Stephen must be in denial.

After listening to the couple’s divergent stories, I tell them that there are ways to objectively explore the discrepancies in their narratives, and to determine the truth without hesitation, or doubt. I tell them about diagnostic tests such as cystoscopy and flowmetry and the available treatment options–behavioral modifications, medications, and even surgical interventions.

All of which Stephen vehemently declines. And so, I have no option but to mark another check next to the second D. Stephen isn’t only in Denial, he is Declining all of my suggestions.

“You see,” Stephanie tells me with passion, “he doesn’t listen!” I immediately mark the third checkbox in my list of D’s–“Doesn’t Listen.”

After three decades of marriage which I define, for the sake of simplicity, as one long training session–a kind of lifelong boot camp, I quickly realize that I am left with only one option: to agree wholeheartedly with Stephen’s wife, his better half, Stephanie.

“Men never listen! They never do!” I hear myself saying. To which she responds with a wide smile, her face brimming with delight. I imagine her thinking: At last, a doctor who listens (a man, but still, he listens), who knows what he is talking about, who recognizes the true nature not only of bladders but of men and women.

Later that day, at home, I searched for evidence of my 3D theory. I asked myself: Are there any research studies that confirm or dispute my observation?

I found several articles on the subject but one of them seems to apply perfectly to my subject matter–Stephanie and Stephen. The article, written by Omar Yousaf, was published in Health Psychology Reviews under the title, “A systematic review of the factors associated with delays in medical and psychological help-seeking among men.”

In his research, Yousaf reviewed a total of 41 articles that included 21,787 participants. He identified several prominent barriers to men’s delay in medical and psychological help-seeking: Men tend to view their symptoms as minor and insignificant (Denial); they feel anxiety and fear when faced with the prospect of medical interventions (therefore they often decline medical help); they fear loss of control and are afraid to be seen as vulnerable; and finally, they lack proper communication skills with health care professionals, partly because of their disinclination to express emotions (they Don’t listen, nor divulge their emotions and thoughts).

After reading all that, I thought: it took millions of years of evolution for men to reach this point, and yet, the result is disappointing. Perhaps, the problem isn’t in biological evolution but in the evolution of the stories women and men tell themselves. By natural selection of their own, certain stories became extinct while others survived–and for too long, we told ourselves about a knight rescuing a princess from a burning tower; and about men bravely fighting one another to protect their tribes or nations. Against such expectations, why would Stephen admit to his poor urinary flow? Why would he submit his perceived masculinity to medical interventions?

Stephen eventually agreed to a treatment plan. On their next visit to the clinic, Stephanie told me that he was now peeing “like a horse.” I didn’t ask how she knew. I already knew that she listens.

Shahar Madjar, MD, MBA, is a urologist and an author. He practices in Michigan, at Schoolcraft Memorial Hospital in Manistique, and in Baraga County Memorial Hospital in L’Anse. Find his books on Amazon. Contact him at smadjar@yahoo.com.