You can’t always choose who operates on you, especially in an emergency, but the sex of your surgeon shouldn’t matter, should it? It just may, according to a Canadian study of 1.3 million people. It also may matter to Black women, who tend to have worse outcomes for many health-related surgeries.
The study reports that women who underwent common elective or emergency surgeries with male surgeons had a 15% higher chance of dying, experiencing a major complication, and/or being readmitted to the hospital within 30 days than they did if a woman performed their surgery.
In contrast, men experience similarly good outcomes regardless of their surgeon’s sex, the study shows.
Exactly why such “sex discordance” exists is not fully understood yet, and the study wasn’t designed to answer this question.
“We hypothesize, based on prior work regarding communication between patients and physicians, that this may underpin the observation,” study author Dr. Christopher Wallis, an assistant professor of urology at the Mount Sinai Hospital and University Health Network in Toronto says.
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Previous studies have shown that female doctors tend to listen more, and their patients may fare better as a result.
“Patients should seek to find surgeons that they trust and communicate well with,” Wallis shares. “As a surgical community, we should seek to better understand the factors underpinning these observations such that we can understand the processes of care that lead to optimal outcomes so all surgeons can use these and all patients can benefit.”
The study included more than 1.3 million patients who had 21 common elective and emergency surgeries between 2007 and 2019. Of these, close to 15% experienced one or more bad outcomes in the month after surgery including death, readmission, and/or a complication. Nearly 46% of patients were of the same sex as their surgeon.
Female patients treated by male surgeons fared worse after surgery, but female surgeons experienced similarly good outcomes whether they operated on men or women, the study shows.
The research took place in Canada, but the findings are likely generalizable to the United States, according to Wallis.
“This study provides new information about the role of sex differences between surgeons and patients and the potential relationship with outcomes by showing that sex discordance does affect outcomes,” Dr. Amalia Cochran, who co-wrote a commentary that accompanied the findings shares.
There simply aren’t as many female surgeons as male ones, Cochran, a professor of surgery at the University of Florida College of Medicine notes.
While there’s finally sex equality in medical school, it’s not yet showing up in surgical ranks: Women made up just 22% of U.S. general surgeons in 2019, the editorial note. That number is even lower for Black women who make up only about 2.6% of all active physicians in the United States.
Women should not be at a disadvantage just because of these numbers, and the study is “yet another reason why as a profession we must be intentional about having a workforce that is representative of the patients we care for and in which we foster belonging for all workforce members,” Cochran shares.
Dr. Cassandra Kelleher, a pediatric surgeon at Massachusetts General Hospital in Boston, says the findings probably don’t relate to differences in surgical prowess or technical skill between male and female surgeons.
“It’s likely due to something more nuanced such as how surgeons listen to people after surgery and the way that they involve family or caregivers, or listen to nurses on the floor who express concern,” Kelleher notes.
Other factors may play a role, too, including how approachable the surgeon is and the level of risk he or she is willing to assume.
The patient-surgeon relationship is extremely important.
“It may be that a woman has a really good rapport with a male doctor, and that is much more important than gender,” Kelleher adds. “All surgeons should place more weight on communication, listening skills and risk assessment to help close these gaps in care.”
How to choose the right surgeon
- Do your own research. Take the time to research the doctors’ credentials and experience on Healthgrades.com. After narrowing down your list, call each general surgeon’s office and ask for a consult appointment to meet and interview the doctor.
- Research the hospital. The quality of the hospital matters. So, consider the quality of care at the hospital where the general surgeon provides care. You should also take into account if the location of the hospital matters to you.
- Choose someone you are comfortable with. You should find a general surgeon who shows an interest in getting to know you, who will consider your treatment preferences, welcome your questions and concerns and respect your decision-making process.
- Watch for red flags. The surgeon’s demeanor matters. Does he or she treat their colleagues with respect? A JAMA study showed that surgeons who behave unprofessionally around their coworkers are likely to have more complications after surgery. You should also ask the surgeon if he or she is receiving any payments from pharmaceutical companies or surgical device manufacturers because these kinds of conflicts of interest may influence your doctor to use a particular type of surgical device, even if it isn’t right for you. You can look up your surgeon on ProPublica’s Dollars for Docs website, which tracks payments to doctors from pharmaceutical and surgical device companies.
Lastly, if you have the luxury, take your time. Surgery is not something that should be rushed into. Once you find a surgeon you trust, take the time to think it over for a few days before scheduling a procedure. You should also be leary of any doctors that try to rush you into surgery for a chronic problem that has been going on for a while.
“People should see a doctor, think about it, weigh the options, come back for another visit and then schedule surgery,” Marty Makary, a pancreatic cancer surgeon at Johns Hopkins says.