Going to surgery is daunting, no matter who you are. There’s a lot to consider, from how you prepare and what your insurance covers to which hospital you choose and your relationship with your health care provider. You may be surprised to learn that even the gender of your surgeon can factor into whether you have complications from surgery, or even survive. And this is even more relevant if you are a woman.
A recent observational study published in The Journal of the American Medical Association looked at how the gender of the surgeon and the gender of the patient affect surgical outcomes and found that women treated by female surgeons were 15% less likely to have complications, readmission to hospital, or death within 30 days of the procedure compared to women treated by male surgeons. And, even more shocking, women were 32% less likely to die when treated by female surgeons.
This research is a follow-up to a smaller 2017 study published in the British Medical Journal that found patients treated by female surgeons had a small but statistically significant (meaning it wasn’t just by chance) decrease in complications and death 30 days after the procedure compared to those treated by male surgeons. This latest research takes things further with a larger dataset and additionally looks at the impact of patient gender.
Unpacking the investigation
A team of scientists studied the records of 1.32 million patients (760,205 women and 559,903 men) treated by 2,937 surgeons in Ontario, Canada, over the course of 12 years. They analyzed the results of 21 common elective and emergency surgeries, including coronary artery bypass surgery, brain surgery, appendectomy, gastric bypass, spine surgery, thyroid surgery, and hip replacement. Nine percent of the men and 12% of the women had female surgeons. What the researchers found across the board was that both men and women fared better when operated on by female surgeons, with patients having significantly better outcomes.
“Because it is such a large study and with so many surgeons, largely trained through standard Canadian training systems, we don’t think the differences are due to technical differences in the operating room; those little variations will show up in the washout,” explained Angela Jerath, cardiac anesthesiologist, associate professor at the University of Toronto and one of the study’s authors.
The study did not look at why these differences in outcomes exist, but it highlights the need for more qualitative behavioral research that all surgeons can learn from, Jerath said.
“The things we look at, complications in particular, are not just a function of what happens in the operating room,” he explained. “They are a function of who is being operated on. They are also a function of how well patients are optimized to undergo surgery. They are a function of how the surgeon looks for changes before or after surgery and how he formulates his plan, how he integrates with other teams. These are softer, non-technical skills that are taught less and could really impact surgeons’ practice.”
What could be behind the findings?
One hypothesis is that the way women communicate, especially with other women, may be what leads to better outcomes. Several studies have shown that women are more detailed communicators than men.
“The lifeblood of health care is communication,” said Dr. Kim Templeton, a professor of orthopedic surgery at the University of Kansas and a member of the HealthyWomen Women’s Health Advisory Council. “You need to be able to communicate with patients to find out what’s going on to make an accurate diagnosis and make sure everyone is on the same page in terms of what a procedure will entail and what the expected or expected results are. are.”
Women also don’t necessarily express themselves or express pain in the same way that men do and may not feel comfortable being completely open with male surgeons. “You see in the study that a patient’s problems with a male surgeon got worse as the woman got older. That could be because the older generation of women is even less likely, as you would see, to challenge authority,” Templeton added. “So if the surgeon doesn’t mention something, the patient can just assume it’s not important.”
Templeton was not involved in the study, but has spent her career researching gender differences in health care and is a past president of the American Medical Women’s Association. She also suggested that women may see better results with female surgeons because female surgeons are bringing their life experiences to bear and are more attuned to the fact that there are gender differences in health conditions.
“Many female physicians, including female surgeons, understand that women’s health conditions can present differently,” she said, noting that when women have symptoms of an impending heart attack, they often rule out anxiety attacks because their symptoms are different. of men Research shows that women who had heart attacks were less likely to die when treated by doctors.
“For patients, when they look at this data, it’s pretty scary work,” Jerath said. “It’s like, should I ask for a doctor now? And the reality is that we don’t have enough female surgeons.”
The need for more female surgeons
In the United States, approximately 22% of all general surgeons are women, with some specialties such as thoracic surgery and orthopedic surgery (which, at 6%, has the fewest women) drastically lower.
Templeton noted that, at the current rate of growth, it would take 217 years for women undergoing orthopedic surgery to catch up with the rest of medicine.
“If we want to continue to improve the field and patient care and make sure we are maximizing the talents of people entering medicine, we have to find a way to make the field more welcoming to both women and women. . underrepresented minorities,” she said.
Factors that affect why there are not as many female surgeons range from misconceptions about various surgical specialties to sexual harassment, lack of work-life balance, lack of mentors, microaggressions, and barriers to moving up the ranks. similar to many other industries.
The work of people like Jerath and Templeton is helping to bridge the gap between male and female surgeons. In the meantime, what can you as a female patient do to defend yourself?
Get all the facts and don’t be afraid to ask questions or express concerns.
“It’s very important that you can have a good relationship with your doctor,” Jerath advised. “Even beyond surgery, where you can communicate your ideas, discuss your options. Discuss what the implications look like after surgery and what exactly the recovery is like. We can’t always avoid complications, but we can minimize them.”