Why are women more likely to die when operated on by male surgeons?

If you are a woman, you should really consider having your surgeon as well; could save your life.

This is because women have a 32% plus odds of dying when operated on by male surgeons compared to female surgeons, according to a recent study.

Although 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 your surgeon had been a man. But why?

The doctor who led the study (published in the specialized journal JAMA Surgery), Christopher Wallis, not sure.

Wallis told the BBC that they don’t have an explanation for these findings yet, but are working on it.

So les we asked several female surgeons what they think about why a woman might be safer in your hands.

Pain perception

The study analyzed more than 1.3 million patients treated by 2.720 surgeons in Ontario, Canada, between 2007 Y 2019.

Claims to be “the first study to address the question of the association between gender concordance between surgeon and patient and surgical results.”

Does not make definitive statements about why female patients can and go worse with male surgeons, but points out possible explanations from other available medical literature.

One suggestion of the study that could explain the findings is that there is a significant difference in pain perception: male physicians “ underestimate the severity of symptoms in patients“.

Oneeka Williams, urologist at Tufts University School of Medicine in Boston , USA, agrees.

“I think there is a male bias to despise 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.

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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 concerns and the symptoms of a female patient”.

Attitudes

Nancy Baxter, colorectal surgeon at St. Michael’s College Hospital of the University of Toronto, also believes that “people tend to underestimate pain in women more than pain in men“, but suggests that they may also be in game other factors.



“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.

He cited literature evaluating patients with heart problems which shows that female cardiologists manage patients better than male cardiologists, which results in better results.

But then it also points out the differences in attitudes towards surgeons men and women.

” During the operation, we know that women surgeons are punished for bad results, if they get bad results at all. It is more likely that they will have a decrease in their references, it is less likely that they will be forgiven for a bad result”, he pointed out.

“And the bad results are attributed to their ability, while in the male surgeons, poor results are attributed to chance, to bad luck”, he added.

“So female surgeons have to perform better to be considered equal”.

Communication

Another underlying explanation could be the “intelligence stronger emotional, empathy, and communication skills in women,” as Williams put it.

Kim Templeton, an orthopedic surgeon at the University of Kansas Medical Center, believes the way her colleagues women approach their patients can help explain the differences.

The doctor-patient relationship is necessary so that l tos people feel comfortableto s by disclosing information that could be critical to making a diagnosis and recommending treatment, he said.

“It allows a greater dialogue about the concerns of the surgery and addressing them early”.

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In fact, studies Previous studies found that the doctor-patient relationship and interaction may suffer if the patient is a woman and the doctor is a man.

However, it is possible that communication problems do not depend solely on the doctor.

The Ontario study notes that women may underestimate postoperative pain and complications in men, and Svahn agrees.

“Patients possibly feel 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 been recognized since long ago and can be a factor for women to leave the profession.

In 2015, the 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 female surgeon.

Williams says that female surgeons are constantly remembers her 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.”

“In the most obvious cases, even after having introduced myself to the patient, discussing the diagnosis, the surgical approach and the risks and benefits, the patient will ask: ‘Who is going to do my surgery?’”.

Williams believes that female surgeons need to “perform much moremore to test your capabilities“ and suggest that this could also be a factor to explain the study findings.

“I think that patients still have the stereotyped 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 maintained.

Gender imbalance

Although Wallis, the main author of the study, emphasizes that this shows a trend in the population and does not mean that a patient will necessarily do worse with a male surgeon, it also illustrates the harsh reality of surgery: in the more than 1.3 million procedures analyzed, the patient She was a woman more than 32% of the time, but the surgeon less than 11% of the occasions.

This relative lack of female surgeons is something that Svahn regrets.

“The treatment of any patient by a surgeon shouldn’t be limited by the fact that there just aren’t enough women in that field,” she said.

“Yes it is true that patients consistently and predictably do better with female surgeons, for whatever reason… we need female surgeons in all surgical fields to be available and accessible to patients.”

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Fiona Myint, Vice President of the Royal College of Surgeons of England, recognizes the need to improve the gender balance in surgery.

“In the United Kingdom, more men than women choose to start training in surgery. The women represent the 30% of this specialty in the initial stage, but only the 30% of the top trainees and the 14% of the consultants”, he points out.

Remaining women 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”.

“He had reduced me to an object in the most misogynistic way and invited this patient not to see me as the surgeon, but as a woman who could be disrespected and whose limits could be rape”, she said.

Overcoming sexism and gender bias will be crucial to attract more women to the profession and convince 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”.

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