Episode 30 : When Men Don’t Talk

Michael Avery:

There’s an old stereotype about men and health. We’re going to explore that a little bit in Life Chapters, Money Choices today. We’ll service the car on time, we’ll replace a dodgy pool pump before it packs up, we’ll spend three weeks researching the correct tyres for a 4×4. In my case, it was probably three months. But when something feels wrong with us, it’ll probably sort itself out. And beneath all of that, there is a much more serious question. I think for many men, health is tied up with lots of things. It’s tied up with identity, independence, work, earning, providing, protecting, all of those things, being the person that other people can rely on. So what happens when illness suddenly challenges all of that? Well, September is Prostate Cancer Awareness Month, but today we want to use that as a starting point for a much broader conversation about men’s health and purpose and ageing. And joining Kim Potgieter and me is Dr Adam Nosworthy, who’s a specialist physician and medical oncologist at Nosworthy Oncology in Joburg, and he’s spent more than two decades sitting alongside people during some of the most uncertain chapters of their lives. So, Dr Nosworthy, welcome. Lyndsay tells me you’re another proud export from V Town, which, if people don’t know, is Vereeniging, which is where my mum hailed from in Three Rivers, and so I’ve got a lot of fond childhood memories. Welcome to the podcast.

Dr Adam Nosworthy:

Thank you very much.

Michael Avery:

I’ve got to ask you, before we go anywhere near cancer and testosterone and mortality and all of those things, let’s just start in Vereeniging. You and your brother both became oncologists. What was in the water in V Town that you and your brother both became oncologists?

Dr Adam Nosworthy:

I would love to be able to tell you. I’m not entirely sure. I always wanted to be a doctor, so that was my starting point from the age of three or four. I came to Johannesburg to study, as I decided to specialise in internal medicine, and then kind of slotted into oncology. And that’s where it all started. We’re very close, the two of us, so Owen just followed. Are you the older or the younger? I’m the older, you can see that.

Michael Avery:

I’ve got no worry, I’m heading in that direction. It’s a good thing we’re having this very brave conversation about confronting our health as we age. It’s amazing. You hit 40, and in fact, I turned 40 during COVID, and there was a meme the other day that said, oh, I blinked, and all of a sudden I’m 46. What’s happened to the last six years? But things do speed up. Your health changes dramatically from 40, and we’re going to get into all of that. Oncology is unusual because you’re dealing with science at an incredibly sophisticated level, but also with all of the fear and the hope and the relationships and the mortality that comes along with that. What attracted you to that particular intersection? Was it something that you started specialising in after the broad specialisation of medicine? You thought, well, this is where I can make a difference.

Dr Adam Nosworthy:

Absolutely. I initially wanted to be a cardiologist. That was my love. But things fell apart in the department at the time, and I had been in oncology, and so that drew me. I’d had a very successful, happy time of six months in oncology as my last rotation specialising, and I kind of just flowed in. It just became who I was. And I’ve loved it. I’ve absolutely loved it.

Michael Avery:

And more than two decades now in oncology. What have patients taught you about people that medical school probably never could?

Dr Adam Nosworthy:

Everybody’s very, very different. People have different views of everything. People have very different views of money, considering we’re talking about that, and different approaches to life. And the bravest of the brave are often the weakest when it comes to being diagnosed with cancer and not being able to tolerate or cope with the diagnosis.

Michael Avery:

I’m sure there’s such a profound shift that happens in your life, in the plans we had internalised, and how quickly those shift. We spoke to Bryony about that when talking about that shock diagnosis that she first got when she was handed her baby and the nurse said she’s got Down syndrome, and how quickly those plans change. But while everyone is different, is it fair to say that men don’t tend to talk about their health? Am I just being a little bit too stereotypical there?

Dr Adam Nosworthy:

No, I don’t think so. I think it’s a very fair assessment of men in general. They do tend to hide things, to just coast along. That little sign that could possibly mean something just gets ignored, or various excuses are made for that disability that somebody else might be noticing and somebody doesn’t want to admit to or recognise. So I certainly think it’s a fair stereotype. Obviously not everybody, but the vast majority of men are hiders of their health.

Michael Avery:

So am I guilty? My partner will always say that it happened to me in December. I stubbed a toe, lifted an entire toenail, big toe on my left foot, off the bed in Swaziland on holiday, and just put a plaster on it and said, no, it’ll be fine. Five days later, it was much worse, and I thought maybe I should have gone and seen the doctor at the first opportunity. It became quite a big issue, fortunately with a good outcome. Why is that? What do you think sits underneath that, without being a psychologist? And I’m going to come to you, Kim, on that point because you can give us a more psychological view. Is it denial, embarrassment? Is it a sense of admitting that something is wrong that makes you less capable, maybe?

Dr Adam Nosworthy:

I think it’s a fear of admitting that you aren’t whole, that you aren’t in control, and accepting that something is going on with you. Men like to be tough, most men. Not me. I suffer with anything, so I’ll let you know very, very early in the course of the disease or whatever. But I think that’s most men. They prefer to maintain that kind of shield around them, that they are the healer, the controller, the person in charge. And it carries on through the decades.

Michael Avery:

Kim, do you see that? Maybe the financial planning equivalent of that, because people will happily discuss investment returns and tax rates, but the harder conversation is, I’m frightened. I don’t feel as capable as I used to. Maybe I haven’t planned as early and I don’t want to admit that.

Kim Potgieter:

So I think there are two things. You’ve said about men keeping it inside, but when a group of women are together and we’re chatting, I’m going to give you a woman’s perspective, not a financial planner’s, Michael. We often talk about man flu. So when husbands get flu, we all call it man flu because they overreact to that, and it’s always much bigger than it really is. But when we’re talking about a topic like we’re talking about now, like a real health concern, that’s where it’s different. I know that because it’s when they’re feeling vulnerable. So if you can say, oh, I’ve got flu, and it’s tough because of everything I’m doing, that’s easy to talk about. But if it’s something to do with, I mean, we’re talking today about prostate, or something to do with bladder, anything to do with the sensitive part for a man, that is a vulnerable conversation. That is a place where, when they have to bring it up, there’s massive shame potentially that they could be feeling. So they keep it to themselves. They keep it internalised, they don’t go and see a doctor, because now there’s this fear. That fear is sitting there and they’re going, this could be really bad, and they just keep it inside. So we as women will share. When things happen to us, we’ve got girlfriends, we call. If you’re a man and something like this is going on, who do you call? Who do you talk to about it? If it’s your partner, sometimes you’re nervous to talk to your partner about it because if you talk to your partner about it, your partner might see you as less than, or your partner might not see you as the provider that you’ve been, and that you maybe, in a way, are pretending to be, that you’ve got it all under control. So for me, that is the difference in these kinds of conversations. And you want to equate it to finances and everything like that. I think, Michael, if I’m really honest, finances are an easier one to talk about for a man because they have their language that they know. But what we’re talking about here is emotions, what we’re talking about here is fear. That is something that you’d much rather internalise, and by internalising it, you’re alone. And the minute you’re alone, it’s really hard to find that right moment to bring it up.

Michael Avery:

Yes, I mean, I’ve met friends who are perfectly comfortable talking about blood pressure or cholesterol or things like that. But I also think if you introduce sexual function, if you introduce things around testosterone, your loss of physical capacity as a man, then that all of a sudden becomes a much more difficult conversation because of all of those things you’ve said. Dr Nosworthy, do you ever encounter a patient who says, well, I knew something wasn’t quite right six months ago, but I thought I’d see how it went? And as a doctor, how frustrating is that?

Dr Adam Nosworthy:

It’s extremely frustrating. It’s extremely frustrating because there is so much that can be done nowadays in terms of detecting any condition, not necessarily cancer, and acting on that condition. Sorting that condition out at an early stage obviously makes it much easier. Whether it’s blood pressure you’re treating, as opposed to some sort of malignancy that may be developing, versus your sexual prowess and that kind of stuff, everything is easier when it’s small. Whatever is small is easy to fix. Something that’s much larger obviously becomes more and more difficult. And so I think it’s a very valid concern, and it gets to you because when someone comes to sit in front of you and they are presenting with cancer that is already spread, when you know that had they presented six months earlier, when those pains or cramps or unusual symptoms started, you could have detected it much earlier and cured their cancer. It’s very, very frustrating.

Michael Avery:

And especially when you know most listeners of this podcast will already have medical aid. Medical aids are all about preventative healthcare, early screening. A lot of that is provided under PMBs, or if not, the medical scheme will provide those regular checks free of charge, not out of savings, and they really want to encourage you to go and get checked as early as you can, because you can solve the problem if you can.

Dr Adam Nosworthy:

You can solve the problem, and the cost of the problem is a lot less as well. I mean, if you can cure somebody’s cancer with an operation versus years and years of chemotherapy or radiation, as an example, you’re talking a good million difference in price. So it’s a lot of money that could be saved as well, apart from the emotional and psychological impact for that whole family.

Michael Avery:

Yes, and Kim, financial planners often talk about replacing income. You can insure an income stream to an extent. You can’t insure someone’s sense of identity, though. So how do you help somebody when the numbers, the calculations of the plan say they’re financially secure, but emotionally they feel anything but secure in a moment like this?

Kim Potgieter:

The big thing for me is the fact that they have someone to talk to about it. Because when you’re on a journey like this, it feels quite alone. You get the diagnosis, and your family are so emotionally involved with it that they can’t really help you through it. So I always say get some kind of help, whether it’s a psychologist, whether it’s a coach, whether it’s somebody that you’re just speaking to, because when you’re alone on it, it’s a difficult journey. I see, because we have many clients who have been diagnosed with, we’re talking prostate today, that’s a huge one that I’m seeing on an upswing amongst our clients. And when they come in, their confidence is gone. So they lose a lot of confidence with it happening. And maybe quite a safe place is just to talk about, are we financially all right? Because it’s something they can control. Because when we’re dealing with having chemo and going through all of that, yes, you’ve got a programme that you’re going to be doing, but you don’t know what the outcome is going to be. But when they sit with us as financial planners, we can look where they stand financially, we can look if something goes wrong, what’s going to be there for their family, are they going to be well looked after? So it is something that they feel in control of, and that is encouraging for them. And then at the same time, it’s just the fact that they’ve been able to share it with someone, because if you can share it with someone, it just isn’t as huge as it is if it’s just with you on your own.

Michael Avery:

And I mean, you’ve lived this personally with Gys’ cancer as well. Did you find that experience taught you lessons that you probably hadn’t thought of or learnt as a financial planner?

Kim Potgieter:

So, it’s always very different when it’s your own family. I remember when the diagnosis came through. I remember the call, and then getting off the call, and my children were standing around, and I was standing there, and he told us it was bladder cancer. And at that present moment, the last thing in my mind that I was thinking about was the finances as the financial planner. It was the last thing. But it was all my husband was thinking about. He took us to his factory, he showed us around, he was telling us what was going to happen when he was no longer going to be there. And instead, for me, the main thing that I got was, you’re going to fight this. You’re going to do whatever it takes and you’re going to fight it, which is exactly what he has done. But really, Michael, at that time, his number one was, you’re all going to be all right. I’ve made sure that you’re all going to be all right. And we were going, stop even thinking about that. We can’t go there. We need to go to what is the treatment, how do you go through the treatment? So it was such a different response.

Michael Avery:

Isn’t that so interesting? Because his response is very much linked to the persona, the identity of the male provider, and that’s something that he can control and what he wants to take control of in the moment, and yours is completely on the other side. I do think, and maybe I’ve got this romanticised idea of illness, if you can have that from the outside, but you have this sense that a serious illness reprioritises things. Dr Nosworthy, do you see that? Does what matters really become a lot clearer after diagnosis?

Dr Adam Nosworthy:

Very much so. Particularly when, as you say, your husband’s concerns were you guys, your concerns were him and his health, and that’s exactly what you see: a family that is more concerned about their loved one than where the next amount of money or salary is going to be coming from. It’s obviously dramatic when there aren’t those things in place, which is sometimes the double whammy for people, and that’s where it tears my heart because then there’s this acceptance that we don’t really have any sort of financial backing or anything while he’s going through this. But it certainly is. It really kind of ignites where your life is heading once you have a diagnosis like that.

Michael Avery:

Yes. But, without sounding callous, having the financial plan allows you to then focus on those priorities.

Kim Potgieter:

If you don’t have the financial plan, then that becomes a focus. I’m so grateful that we did have the financial plan, that we did know everything that could possibly happen, and this is what I did as a job. But for me, maybe just one thing to add here that I found interesting. My husband didn’t want people to know. Again, you ask yourself, why don’t you want other people to know? Because it’s something that’s happening to you, and it’s happening to so many people. But what we found was wherever we went, and it’s kind of this empathy miss, if you did tell somebody, they would always have a story to tell you about somebody who lived or somebody who died who had the same thing, or what somebody did, or who they saw. So there are always people meaning well by giving all this advice and then giving you all these stories. I share that because so many times when people do share, that is a complete empathy miss, and that’s why they stop sharing. And I was sad for my husband that he couldn’t share and he didn’t want to tell people, but that was because of the response he was getting. Whereas if people had just let him speak and say what he was going through, I think the journey would have been so much easier for him. I’ve seen it happening so many times, and I think especially for men, when they do want to share with us, we need to let them share it because it’s so important for them to get their confidence in sharing, otherwise they’re just keeping so much to themselves.

Michael Avery:

That’s a great bit of insight, Dr Nosworthy, isn’t it? Be good listeners to those who’ve received the diagnosis.

Dr Adam Nosworthy:

Absolutely. I think that is one of the bigger problems that we face from a medical point of view, that there’s a lot of negativity. People remember the bad about a certain condition, a heart valve that’s blocked, a cancer treatment that went wrong, and what happens is they tend to present that to the person. That is their natural, oh, I know somebody that passed away after three days when they had their heart attack. I know four people that had radiation and they all had significant side effects. And then it does. It not only demotivates the person who’s just been diagnosed, it makes them not want to talk to anybody because they just get a negative back. So it’s very much the case, yes. Certainly.

Michael Avery:

You’ve probably had hundreds, if not thousands, of these conversations that most of us hope never to have, without betraying any patient confidentiality, obviously. But what changes do you most commonly observe after somebody hears those three words: you have cancer?

Dr Adam Nosworthy:

It’s interesting because there’s a whole gamut, a spectrum of various responses. You get some people, a small minority, who automatically say, don’t worry, we’re going to fight this. I want the best. I’m taking this on. And that’s encouraging. It’s nice to have somebody who is motivated to hit this running. You get the vast majority of people who sort of just sink back and go quiet. They withdraw into themselves, they withdraw into their family groups, and sometimes it takes a couple of visits to get that motivation going. And by far, I think you could probably get about 60 to 80% of those people motivated and ready to fight. And then you get people who are negative, a good 20% of them, and into alternative therapies and that kind of approach to medical conditions. And no matter what you do, no matter how you try and involve yourself, how you try and persuade, how you try and motivate, it’s just a no-no. They’re happy to go off on their own and do their own thing. I think it’s that big group in the middle where most of the difficulties come, because they’ve got different people pulling them in different directions. So they’ve got me trying to encourage them and get through what’s going to be a long journey. They’ve got their family, who are very supportive, but also doing all their research online and everywhere. Everyone becomes an expert.

I always say, do it, and we can go through all of the things, but sometimes it can really have an effect on the person who is suffering, because now their family have given them a different kind of idea. Then you’ve got the friends, if they’re very close friends and are involved, and you see that some people have very, very good friends. Mainly women come with their friends. It’s actually quite nice because every time they come to see you, they have a different friend and everybody wants to experience that entire journey with them. Whereas most men will come on their own. Occasionally they’ll come with a wife, but sometimes the wife is told to stay away. He’s fine, you know. So it is that kind of approach. I’m thinking of someone in particular at the moment who has a medical spouse and makes that spouse stay at home. All she wants to do is be there and assist and help. But is there that bravado that comes out, that I’m fine, leave me alone, I’m handling this?

Michael Avery:

It’s very much a male South African thing that we have. I think it’s a good thing. We see lots of videos at the rugby on the weekend, and Cheslin Kolbe breaking his jaw and then taking a little video with it afterwards and almost wearing it like a badge of honour. It’s cultural. It’s very difficult to get over that. I want to stay with Dr Nosworthy just for a second longer, with the idea of how we age and age with a bit of confidence versus being so paranoid that we think every ache or pain is the next trip to see Dr Nosworthy because I think I may have some kind of cancer. Because, as I know, sexual energy does decline after 40 to an extent, hairlines recede, and I just look at something from Zuney’s and pick up weight. So how do I distinguish between this is simply part of ageing versus this is something I should actually go and talk to my doctor about?

Dr Adam Nosworthy:

Well, I think that’s a very, very good question. It’s a very difficult question to answer because a simple ache or pain could ultimately be something very serious, whereas 90% of those are probably just a simple ache or pain because we’ve reached too high for a pillow in the cupboard or something like that and injured a muscle. I think the most logical approach to something like that, or anything that comes along as you’re ageing, is: is it there for a long period of time? I’ve got a pain today, it’s there tomorrow, it’s there the next day, and it’s increasing in intensity. Well, then that’s a little bit concerning. If it’s staying the same and it doesn’t want to go away after a week, that is concerning. If it’s gone in three days, there was nothing to worry about. So I think it’s just a very logical approach. Well, I’d like to think most people are logical in the way they see things, and just go, after a week, this shouldn’t still be here.

Michael Avery:

Why is this persisting?

Dr Adam Nosworthy:

Exactly, and you’re heading off to go and do it. I’d rather you go and do 25 X-rays and then we can put your mind at rest than you just say, oh, let’s watch it, let’s watch it, let’s watch it. So yes, I think it’s being sensible and having what I think many South Africans no longer have, which is that family general practitioner. We’ve all taken to emergency rooms, so Milpark, Sunninghill and Morningside, and we’re rushing off there for this or that. I’ve been busy during the day, I couldn’t go. So at 10 o’clock at night, you rock up at the emergency room just with a minor pain or ache or something. And having that general practitioner, there are a couple of good general practitioners still in Johannesburg. The difference when you see their patients versus people who don’t have a general practitioner is quite obvious. They have a much calmer approach, they’ve already discussed everything and they realise that this may be something serious and they’re going to have a couple of tests. Everything has already been explained. Whereas in that emergency room, it’s: well, it might be cancer, and you’re sent off to go and do an X-ray and nobody talks to you, and next minute, yes, now you’re visiting the oncologist. It’s a very rapid, dramatic entry into medicine and oncology.

Michael Avery:

I think that’s such an interesting insight as to the importance of having a good and trusted general practitioner in your life, much like we advocate for a financial adviser that you trust.

Kim Potgieter:

And generally going through something like what you’re talking about, and with financial planning, it is the same, because when we’ve already got a plan, we’ve worked towards it, we’ve talked about what happens if the unexpected happens, we’ve got the things in place if it would happen. All of a sudden you’ve got somebody that you already trust to have these discussions with. So yes, that’s such a good point.

Dr Adam Nosworthy:

I couldn’t agree with you more there because the vast majority, let’s face it, oncology, cancer, is not a fun diagnosis, and everybody immediately goes, I’m going to be dead. I’m dying. And obviously things change and I spend a lot of time discussing that. But the vast majority of people who don’t have somebody who can assist in their financial world end up, a lot of times, with me advising them: you need to claim this, you need to do that, go and ask them for forms. Oh, can we get money? Yes, you’ve been paying money every month. It’s amazing how many people don’t understand or don’t know how to traverse that because they’re also emotional.

Kim Potgieter:

So because you’re going through something so emotional, you talk about logical thinking. The logic goes out the window completely.

Michael Avery:

I actually saw Kim’s eye roll there when you said you hope most people are logical, but in those states, it’s like divorce as well, as we’ve discussed in the past. In the heat of that moment, you’re not asking the questions that you should be about retirement funds and that kind of thing. And medical schemes are difficult to traverse at the best of times, let’s face it. So that’s where I get a lot of really good insight from my financial advisers, helping me navigate the labyrinthine PMBs and formularies and all of those things that come along with medical schemes. And they’re expert at it. I just send it off to them, they get it done, and it gives me peace of mind as well at the end of the day. Dr Nosworthy, it’s September, it’s Prostate Cancer Awareness Month. Let’s just spend a few minutes on something practical. If there’s a man listening to us who hasn’t thought about prostate health for years, or possibly ever, what do you want him to know? Who should be having the conversation with their doctor and what does that first conversation involve if they’re concerned?

Dr Adam Nosworthy:

Look, I think anybody from the age of 50 upwards should have a trigger to have that conversation with their doctor, and ideally their general practitioner. The vast majority of us, as I’ve said, head off to specialists, and that’s a completely unnecessary kind of elevation of an unnecessary problem. Looking at their prostate in terms of a blood test, and that’s all it is nowadays, a blood test to look at your PSA and give us an idea of whether there is a production of an excess amount of that protein, PSA. And only then would that general practitioner say, it’s slightly elevated, but it’s still within the normal range, let’s do it in six months’ time again and repeat it, or this is through the roof, it’s highly likely that something is going on and we need to take it forward. You need to have a biopsy, you need to go and see a urologist and have that. So I think the biggest clue to anybody who may develop prostate cancer or prostate problems is what we call the lower urinary tract symptoms. And again, men don’t like talking about it, particularly as we age. We have trouble passing urine because the prostate enlarges and the urethra passes through the prostate and it gets squashed. Essentially, you’re creating a dam wall for your bladder to enlarge and cause you problems. So difficulty passing urine, burning or pain when you pass urine, and dribbling. Those are probably the most important symptoms that someone must be aware of. Again, you may not have prostate cancer. It may be a urinary tract infection, it may be something else, but don’t ignore it. Because if you detect that prostate cancer early, it can be cured with minimal intervention.

Michael Avery:

That is the bottom line, isn’t it? And how much has the treatment changed over your career as you’ve seen it evolve? I say this because everyone’s talking now about AI, and there have been some amazing breakthroughs in AI and oncology. How have you seen it evolve?

Dr Adam Nosworthy:

So, in terms of the treatment for prostate cancer, I’m going to say we’re still very much old-fashioned. There are three options: chemotherapy, surgery and radiation. While there are those same three options that there were in 1980, the administration of the chemotherapy and the radiation has changed significantly, and the surgery is now being performed by robots. So if you want to bring AI into it, the robot is performing that surgery. It has changed significantly. It’s minimally invasive in terms of the radiation, and the side effects are a lot less than they were 20 or 30 years ago.

Kim Potgieter:

Maybe one thing I could just mention, having a lot of clients who have had their prostates removed. A market or an area that I think should be added to all of this is the post-care of what they go through emotionally. So what I see is confidence dropping. I see their role changing in their family, and they start questioning what value they’re bringing. So for me, if we get cured and we go into remission, let’s say we’re in remission, what is the support in rebuilding your identity? What is the support in all of this? Because I see a lot of change in their earning power, their ambition, and then if they hadn’t had all their financial plans in place, a lot of my conversations are just helping them work out that they’re still important to their families, they’re still valuable to their families, they’re still a great contributor. So I haven’t found a place that I could send clients to, so if you have it, I’d love you to bring that up.

Dr Adam Nosworthy:

Absolutely. There’s the Prostate Cancer Foundation of South Africa, which has a brilliant support network of men who have been through prostate cancer and has support groups around the country. And I think that is probably the best thing for a man, to go and speak to other men who have had the same condition as them, rather than speaking to a friend who’s 40 years younger and does not quite grasp that kind of seriousness or the emotional impact that the condition has had. So absolutely. It’s great, we cure people, but a person then sits and says, I’ve had cancer, and re-evaluates everything about their life, not necessarily wanting to continue working until three o’clock in the morning every day. They go, hold on, I haven’t been on holiday, I haven’t taken the kids away for Christmas, whatever. They tend to want to re-evaluate their entire life, and it’s an important place where finances come into it because have they got the right information? Have they invested correctly? Have they planned for this eventuality?

Michael Avery:

Kim, this is where preparation, as we’ve been talking about it on this podcast series, really does matter. What are those structures that become enormously valuable when life suddenly stops following the plan, and making sure you’ve got something that you’ve maybe stress-tested? It’s very interesting, Dr Nosworthy, to hear you say that often patients will talk to you about the money. Do you find that quite a common thing? Before I go back to you, Kim, this idea that, okay, I’m in the middle of this. Do they talk to you just about the cost of treatment, or is it how long will I be away from work? Can the family cope? Do you almost become a quasi-financial planner?

Dr Adam Nosworthy:

I do, unfortunately, and that’s not my speciality at all. But you’re 100% correct, and most of them do. Fortunately, they tend to think, well, I’ve got medical aid and the treatment is going to be covered. That’s not always the case either, but at least the vast majority of the costs involved will be taken care of. But they realise if I’m not going to be able to work, do I have an income? Great if you’re associated with a large corporate and you’ve got cover, but if you’re a standalone businessman, that’s when you see the tragedy and the heartbreak set in, when they realise that they can’t just sit back and take the treatment, take whatever comes. They’ve got to carry on working and they’ve got to keep that business going because they’ve got nothing in place to take care of them should something happen. What also gets to me is that the vast majority of people, particularly the younger people, younger guys, 40, even 30s, have got nothing in place, then all of a sudden realise, oh, I haven’t got anything in place, and want to start applying for life insurance and this. That’s the heartbreak when I say that no one’s going to give you life insurance because you’ve just been diagnosed with cancer. It’s not something you can do after the fact that people just do not understand, which is very worrying and very, very upsetting because you see the disappointment and then they realise that if I am going to die, my family is not going to be left with anything except my debt. Kim?

Kim Potgieter:

Well, that’s where the risk planning comes in. One of the parts of everything we do is risk planning, and the risk planning is for the what-ifs. So, yes, we won’t get accepted into life insurance if we haven’t been paying it from before the diagnosis. Income protection really helps from the point of view that you buy yourself some space, so you’ve got an opportunity to heal. It’s the same as dreaded-disease cover because if you’ve got dreaded-disease cover, you get the payout and you can then put all your focus into actually getting better, as opposed to having to work and try to do this, so your chances aren’t as great. But again, it’s an uncomfortable conversation when you bring up risk and they go, it’s quite a grudge purchase. If you think about life insurance, all of it is costly. Do I really have to? I need to pay for the education of my kids, I need to sort this out, I need to do that. Do I really have to have that? Yet we just see what peace of mind it gives people, that they can get through the what-ifs of life. Look, we all know life’s not straight, it never just goes according to schedule. We have all these ups and downs. That’s why we have Life Chapters, Money Choices as the name of our podcast. That is what we’re all facing. So having that risk plan in place, knowing that you’re just doing it, yes, it’s a grudge purchase, but it’s really there if something does happen, just to help your family.

Dr Adam Nosworthy:

I think absolutely, I couldn’t agree with you more. And it’s interesting, it’s also cultural.

Michael Avery:

Yes.

Dr Adam Nosworthy:

Different population groups, if you want to split it again, have different views of insurance, of payouts, of what they expect from the government, in terms of they have to pay me now. There’s a huge lack of financial understanding, for males and females, of the entire insurance industry in our lives and how it plays. A lot of people from different population groups have different ideas, and some have a very negative view of insurance companies and don’t want to waste money. So yes, it is very difficult. I think there’s such a balance.

Kim Potgieter:

There’s such a balance because when you are sold things, you’re told all these stories and then you get sold it, and then these people aren’t there in your life going forward. That’s even worse. So for me, it’s all about getting a plan, because if you’ve got a plan for investments as well as for risk, as well as estate planning, you’re not just being sold something out of fear.

Michael Avery:

Yes.

Kim Potgieter:

You’ve got a plan.

Michael Avery:

And you feel financially prepared, which can help in the preparation for a change that could happen. And as you’ve said, nothing is linear in life. But I get your point, Dr Nosworthy, about the changes that we need to see happening in communicating the value to the broader population. There are far too many life policies that are sold for funerals, for example, and the misselling that happens over there, which is playing on a particular cultural group’s fear. That in the industry, I’m afraid to say, is something that has got to change. And it leads to that erosion of trust. But just as we’re running out of time, I’ve got to ask you, and you’ve spent your career watching people encounter this unpredictability of life and have this financial conversation as well as this emotional conversation. The other stereotype is that doctors are notoriously not good with their own money. Has it influenced your own money journey and the way you are? Are you more conservative, more inclined to save?

Dr Adam Nosworthy:

I’ve always been on the conservative side. I remember when I was a teenager, I think Barclays Bank introduced Bob-T cards, and that was what I wanted. I wanted a Bob-T card. Those were cool, they were like lumo and they had that look. I’ve always been given the idea of being prepared for life from my parents. So I sat down when I qualified. Obviously, I wouldn’t earn anything until I started working, which is late as a medical graduate, at 25. And yes, I sat down and made sure I had income protection, I had life insurance, I’m not sure for who at that point. But it was a lot cheaper than waiting until I’m 50, and it stood me in good stead. I was diagnosed with an arthritic condition that has limited my work ability, and it has been reassuring to have that ability to make a claim and to have that peace of mind that I can still work, but I don’t have to work to the extent that I was working before, and I can enjoy my work.

Michael Avery:

Because you are that entrepreneur that you just mentioned, the sole proprietor as a doctor. I’m very much in the same boat and looking forward to having my own risk planning and financial conversation with Kim Potgieter as well. Thank you, Kim. We’re going to have to leave it there. Dr Adam Nosworthy, thank you so much for having a really important, critical conversation and, sadly, a conversation that far too many men don’t have. Hopefully, we’ve maybe just piqued a little bit of self-awareness and introspection by having this one on Life Chapters, Money Choices.