Patients have better outcomes with female surgeons, studies find

As someone who has unfortunately had to have a few surgeries, three were done by women and had no complications and the healing time was a lot less than anticipated. Five were down by men and although they were classed as minor four of them needed further corrective surgeries.

Female surgeon did a great job with my abdominal hysterectomy. Every HCP who has seen the scar since has commented on how neat it is. You can barely see it several years on.

I have a theory that male hairdressers are better, on average, than female hairdressers, because they have to really want to do it: it’s not something a man would ever just fall into.

Interesting - I have always found the opposite. I find male hairdressers won't listen to what you actually want, and they also seem to expect female customers to be fan-girls and hang on their every word/be grateful for their attention.

If I’m ever in a position to require serious surgery, and actually have a choice of surgeon, I’ll bear it in mind!

That said, sadly it’s not surprising. I understand the medical profession is still incredibly sexist and it’s harder for women to make their way, especially in some specializations. Women who are surgeons are probably those who really, really wanted to do it, so pushed on despite being treated badly. Not exactly the same, but I have a theory that male hairdressers are better, on average, than female hairdressers, because they have to really want to do it: it’s not something a man would ever just fall into.

Of course, beyond that, it’s harder for women to succeed in many professions. Those who make it through the sexist hiring processes are probably better, on average.

I don’t doubt it’s true and if there’s a difference in the operations because men tend to do the more complex/risky operations, there’s probably a sexist reason for that too.

You’ve stereotyped the responses to and results of discrimination.

Yes, the hypothesis can’t be tested with any scientific rigor.

Plus this study looked at records on patient health 90days and 1yr following surgery looking only at surgeon and anaesthesiologist. Guess who else is involved? All the nursing, physiotherapy care and the patient’s self care.

Where is the stereotyping?

It is established fact that black doctors face discrimination. The only speculation is the hypothesis that black surgeons may have better than average outcomes. That’s not a stereotype - on the contrary, I’m explicitly saying that, if true, it would likely be an artefact of the discrimination.

So where is the stereotyping?

It would never be possible to test in the way you seem to want. You can't just do full science with randomised trials in surgery, the surgery has to happen for a reason.

It’s just more stereotypical suggestiveness as far as I am concerned, a hypothesis that cannot be tested.

As I explained, it’s a hypothesis, but a hypothesis based on a tonne of data about the discrimination that black HCPs generally and international medical graduates, in particular, face.

Suspectulate as much as you like, don’t make it true.

I don’t think they had time to really do anything in depth.

They looked at 1.2m records in slightly over 3 months (15 July - 20 October 2022) . That’s around 13,700 records per work day. The team listed was 17 researchers.

I agree the suggestions are 100% stereotypes.

I said something to that effect when my niece asked me why Simone Biles, Serena Williams, Lewis Hamilton et al seemed somehow 'superhuman' (her words), had to really stop and consider my response.

I suspect that, if you did a similar study by race of surgeon, you would see better outcomes for black doctors because- like women - they tend to pay a higher professional price for errors and for perceived arrogance, so will tend to be more cautious. Like women, they also face higher barriers to becoming surgeons, so those who succeed tend to be of higher than average quality so, unsurprisingly, have higher than average results.

This would not mean that women or black doctors are intrinsically better surgeons, by virtue of their sex/race. It would actually be a marker of the discrimination they face, and a depressing finding, not something to be celebrated.

The researchers may have tried to correct for variables. That doesn’t mean they have succeeded. There are thousands of potential confounding factors, when you consider the patients, the hospital environments, the surgery, and the surgeons. It is impossible to correct for them all, which is why those of us who are doctors ourselves are cautious.

It is also highly questionable how useful this is to female surgeons. It’s actually reinforcing stereotypes.

The thing is they are merely suggestions. The abstract says it’s an association, not a correlation or causation. They’d have a to show causation and that these suggestions are causes for there to be any good reason to address them.

As it stands it’s just a lot of guesswork- which you should brush off.
I’d do the same if a study were published and the sexes were swapped.

Their conclusion is worded correctly that all they can say is that the 1.2 million records reviewed only suggest female surgeons are associated with better outcomes 90days and 1yr following surgery.

Yeah, so if anyone has a link to a free full text of the whole study in JAMA, I’d be interested. As it is the abstract says it’s an “association” which basically means “interesting pattern”. It’s not a correlation. It’s not a causal link.

I need to read the study more closely before I can comment. Male surgeons tend to take on the higher risk patients in the first place, so the slightly higher complication and death rates could be due not to the surgeon, but to the complexity of the cases they are taking on instead.

It’s not so simple as heart transplant = heart transplant when looking at like for like.

It's complicated, there's a More Or Less on BBC Sounds from 19th Jan last year looking at the stats which is worth a listen. The low number of female surgeons definitely has an influence.

Agree. I am always suspicious of these studies because it is almost impossible to eliminate all the potential variables. I am also not sure that they are helpful for women surgeons - it's another way of delineating them as abnormal, albeit in a more positive light than usual.

We should be trying to identify behaviours and techniques that improve patient safety, not stereotyping those behaviours as male or female.

There are a lot of reasons women are less likely to go into surgery, one being that women doctors don't want to work as many hours, and surgical training is very demanding in that sense, and another being that they often prefer more patient involvement.

I lend more credence to the impact of the revelations (that surprised no-one) in surgery's recent #MeToo.

https://www.thetimes.co.uk/article/metoo-moment-for-nhs-as-female-surgeons-speak-out-qzw3tbs56

https://www.bbc.co.uk/news/uk-england-suffolk-66156441

He's right though, it is often difficult to rule that kind of thing out entirely, even when you try and account for it. I read him as just being careful not to jump to conclusions.

What I wonder is whether female surgeons are more likely to communicate to patients about expected outcomes, and work with them to make decisions which will be most likely fulfill the needs of the patient. Which in some cases might mean not doing surgery at all.

I'd also believe working more slowly though. When I was in the military, overall we found in training soldiers to shoot, women did really well compared to young male requites,. They listened and applied lessons carefully.

There are a lot of reasons women are less likely to go into surgery, one being that women doctors don't want to work as many hours, and surgical training is very demanding in that sense, and another being that they often prefer more patient involvement.

I'm unsurprised at it. I'm unsurprised, but bloody hoping mad at Tim Mitchell, President of the Royal College of Surgeons in England immediately, and publicly assuming that it was because they were doing easier operations, despite the study accounting for differences in surgeries. And I'm a bit bewildered that there doesn't seem to be much backlash to his comments.