Why are women more likely to die when operated on by male surgeons?
If you’re a woman, you really should consider having your surgeon as well; could save your life. This is because women are 32% more likely to die when operated on by male surgeons compared to female surgeons, according to a new study.
While the sex of the surgeon made very little difference for male patients, the study also found that women were more likely to experience complications and be readmitted to the hospital within 30 days if their surgeon had been a man. But why?
The doctor who led the study (published in the journal JAMA Surgery), Christopher Wallis, isn’t sure. Wallis told the BBC that they don’t yet have an explanation for these findings, but are working on it. So we asked several female surgeons what they think about why a woman could be safer in his hands.
The study analyzed more than 1.3 million patients treated by 2,937 surgeons in Ontario, Canada, between 2007 and 2019 and claims to be “the first to address the question of the association between surgeon-patient gender concordance and surgical outcomes.” ”.
It makes no definitive statements about why female patients may fare worse with male surgeons, but points to possible explanations from other available medical literature.
One suggestion from the study that might explain the findings is that there is a significant difference in pain perception: male doctors”underestimate the severity of symptoms in patients”.
Oneeka Williams, a urologist at Tufts University School of Medicine in Boston, USA, agrees. “I think there is a male bias to look down on female complaints. They are likely to think that women are more anxious and hysterical and therefore pay less attention to postoperative complaints. Complaints are dismissed, pain is minimized and the severity of the disease is often dismissed and ignored,” he told the BBC.
Jennifer Svahn, a vascular surgeon at Northwell Health University in New York, agrees. Svahn thinks the high death rate may be because “Male surgeons are more likely to override or marginalize a female patient’s concerns and symptoms.”
Nancy Baxter, a colorectal surgeon at St. Michael’s College Hospital at the University of Toronto, also believes that “people tend to underestimate pain in women more than pain in men”, but suggests that other factors may also be at play.
“When you see the patient, what kind of decisions do you make as a surgeon? Who are you taking to the operating room? There is a possibility that there are differences between surgeons in terms of their gender and how they treat male and female patients,” he told the BBC.
The doctor cited literature evaluating patients with heart problems showing that female cardiologists manage patients better than male cardiologists, which results in better results. But then he also points out the differences in attitudes toward male and female surgeons.
“During the operation, we know that women surgeons are punished for bad results, if they get bad results at all. The more likely they are to have a drop in their referrals, the less likely they are to be forgiven for a poor outcome,” he noted. And he added: “And the bad results are attributed to their skill, while in male surgeons, the bad results are attributed to chance, to bad luck.”
“So female surgeons have to perform better to be considered equal.”
Another underlying explanation could be emotional intelligence, empathy and communication skills strongest of women as Williams put it.
Kim Templeton, an orthopedic surgeon at the University of Kansas Medical Center, thinks the way her female colleagues approach their patients may help explain the differences. Too, the doctor-patient relationship is necessary for people to feel comfortable revealing information that could be critical to making a diagnosis and recommending treatment, he said. He added, “It allows for more dialogue about surgery concerns and addressing them early.”
In fact, previous studies found that the doctor-patient relationship and interaction can suffer if the patient is a woman and the doctor is a man. However, communication problems may not depend solely on the doctor. The Ontario study notes that women may underestimate postoperative pain and complications in men, and Svahn agrees. “Patients may be less intimidated by female surgeons. Therefore, they are more likely to communicate openly and comply more with instructions,” he said.
“I see myself as a surgeon”
Gender discrimination in a field that is dominated by men has long been recognized and can be a factor in women leaving the profession.
In 2015, female surgeons took to Twitter to challenge this situation with the slogan “#ILookLikeaSurgeon” (#meveocomocirujano). Still today, the hashtag has many messages about how women in the profession are routinely mistaken for a different role, with almost anything other than a surgeon.
Williams says that female surgeons are constantly reminded of their gender. “Most patients and staff assume I’m anything but the surgeon,” she said. “The most frequent assumptions are that I am the medical assistant, secretary, dietitian and, if I am lucky, the nurse,” she said, adding: “In the most obvious cases, even after I have introduced myself to the patient, discussed the diagnosis, the surgical approach and the risks and benefits, the patient will ask, ‘Who is going to do my surgery?’
Williams believes that Surgeons need to “perform much more to prove their capabilities” and suggests that this could also be a factor in explaining the study’s findings.
“I think patients still have a stereotypical belief that male surgeons are superior. We are very self-aware and approach each patient with the added pressure of dispelling perceptions that we are inferior to male surgeons. We cannot afford to make mistakes,” he said.
While Wallis, the study’s lead author, emphasizes that the study shows a trend in the population and does not mean that a female patient will necessarily do worse with a male surgeon, it also illustrates the stark reality of surgery: in more than 1, 3 million procedures analyzed, the patient was female more than 57% of the time, but the surgeon less than 11% of the time.
This relative lack of female surgeons is something Svahn laments. “The treatment of any patient by a female surgeon should not be limited by the fact that there simply aren’t enough women in that field,” she said.
“If it’s true that patients do consistently and predictably better with female surgeons, for whatever reason … we need to make female surgeons in all surgical fields available and accessible to patients.”
Fiona Myint, vice president of the Royal College of Surgeons in England, acknowledges the need to improve gender balance in surgery. “In the UK, more men than women choose to start training in surgery. Women make up 41% of this early-stage specialty, but only 30% of senior trainees and 14% of consultants,” she notes.
The women who remain are likely to face sexism in the workplace; Williams says it’s an almost everyday experience for her.
Late one night, she remembers being called to the emergency room to see a male patient. To make him feel comfortable, the nurse joked with him and advised him to “control himself and not flirt with her”. “She had reduced me to an object in the most misogynistic way and invited this patient to see me not as the surgeon, but as a woman who could be disrespected and whose boundaries could be violated,” she said.
Overcoming sexism and gender bias will be crucial in attracting more women to the profession and convincing them to stay. But for now, it seems that Baxter is right when he points out that “when people think of surgeons, they think of men.”