1. A lot of people won't go to a doctor in the united states

2. They may be so used to pain they don't think to mention it.

3. A lot of people lie to their doctors for one reason or another.

In the US there’s also deep religious influence that paints suffering as virtue that’s been exploited by capitalists to establish a norm of pushing through the pain and continuing to work instead of taking a break to figure out what the root cause is and address it. Some also just don’t have a choice, because taking time off means not getting paid which means losing a roof over their head.