Going into surgery is daunting no matter who you are. There’s a lot to consider, from how you prepare and what your insurance covers to the hospital you choose and your relationship with your healthcare provider. You might be surprised to learn that even your surgeon’s gender can determine whether you have complications from surgery — or even whether you survive. And it’s even more relevant if you’re a woman.
A recent observational study published in the Journal of the American Medical Association, examined how the sex of the surgeon and the sex of the patient affect surgical outcomes, finding that women treated by female surgeons were 15% less likely to have complications, readmission to hospital, or death within 30 days of surgery compared to women treated by male surgeons. And, even more shockingly, women were 32% less likely to die when treated by female surgeons.
This research follows a smaller 2017 study published in the British Medical Journal which found that patients treated by female surgeons had a small but statistically significant (meaning it was not by chance) decrease in complications and deaths 30 days after the procedure compared to those treated by male surgeons. This new research goes further with a broader data set and further examining the impact of patient gender.
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 looked at the outcomes of 21 common elective and emergency surgeries, including coronary artery bypass surgery, brain surgery, appendectomy, gastric bypass surgery, spinal surgery, thyroid surgery and blood cell replacement. hip. Nine percent of men and 12% of women had female surgeons. What researchers have found across the board is that both men and women fare better when operated on by female surgeons, with female patients achieving significantly better results.
“Given this is such a large study and there are so many surgeons trained largely through standard Canadian training systems, we do not believe the differences are due technical differences in the operating room; these small variations will eventually disappear,” explained Angela Jerath, cardiac anesthesiologist, associate professor at the University of Toronto and one of the authors of the study.
The study did not examine Why these differences in results do exist, but they highlight the need for further behavioral qualitative research that all surgeons can learn from, Jerath said.
“The things we looked at, the complications in particular, are not just a function of what happens in the operating room,” she explained. “They are a function of who had surgery. They are also a function of how patients are optimized to undergo surgery. They depend on 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 soft skills that are less well taught and could really impact the way surgeons practice.
What can be behind the discoveries
One hypothesis is that how 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 soul of health care is communication,” said Dr. Kim Templeton, professor of orthopedic surgery at the University of Kansas and member of the HealthyWomen’s Advisory Council on Women’s Health. “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 about what a procedure is going to entail and what expected or expected results are.”
Women do not necessarily express themselves or express pain in the same way as men and may not be comfortable being completely open with male surgeons. “You see in the study that a patient’s problems with a male surgeon get worse as the woman ages. This could be because the older generation of women are even less susceptible, as they would see , to challenge authority,” Templeton added. “So if the surgeon doesn’t bring something up, the patient may 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 might see better outcomes with female surgeons because female surgeons bring their lived experiences to the table and are more aware that there are gender differences in health conditions.
“Many female physicians, including surgeons, understand that women’s health issues may present differently,” she said, pointing out that when women show symptoms of an impending heart attack, they are often dismissed as having anxiety attacks because their symptoms are different. men. Research shows that women who had heart attacks were less likely to die when treated by female doctors.
“For patients, when they look at this data, it’s pretty scary work,” Jerath said. “It’s like, Should I ask for a female doctor now? And the reality is, we don’t have enough female surgeons.
The need for more female surgeons
In the United States, about 22% of all general surgeons are women, with some specialties like thoracic surgery and orthopedic surgery (which at 6% have the fewest women) are considerably lower.
Templeton pointed out that at the current rate of growth, it would take women in orthopedic surgery 217 years to catch up with the rest of medicine.
“If we want to continue to improve the field and patient care and ensure that we maximize the talents of people entering medicine, we need to find a way to make the field more welcoming to women as well as underrepresented minorities” , she said.
Factors that explain why there aren’t as many female surgeons range from misconceptions about different surgical specialties to sexual harassment, lack of work-life balance, lack of mentors, microaggressions, and barriers to promotion – as in many other industries.
The work of people like Jerath and Templeton is helping to narrow the disparity between male and female surgeons. In the meantime, what can you do as a patient to defend yourself?
Go there knowing all the facts and don’t be afraid to ask questions or voice your concerns.
“It’s really vital 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 exactly what recovery looks like. We can’t always avoid complications, but we can minimize them.