Patients have better outcomes with female surgeons, studies find

[IwantToRetire]

Differences in technique, speed and risk-taking suggested as reasons for surgery by men leading to more problems

Doctors in Canada and Sweden reviewed more than 1m patient records from two separate medical registers and found that patients seen by female surgeons had significantly better outcomes with fewer problems in the months after the operation.

The researchers are investigating potential reasons for the differences, but the records suggest that female surgeons tend to operate more slowly and may achieve better results by taking their time in the operating theatre.

Dr Christopher Wallis, who led one of the studies at Mount Sinai hospital in Toronto, said the findings should prompt male surgeons to reflect on their approach to surgery and learn from female colleagues for the benefit of their patients. “As a male surgeon,
I think these data should cause me and my colleagues to pause and consider why this may be,” he said

https://www.theguardian.com/society/2023/aug/30/female-surgeons-patient-outcomes-better-studies

I was sure this was an old story but seems to be similar to this one
Women more likely to suffer death or complications if operated on by a man
https://www.mumsnet.com/talk/womens_rights/4425995-Women-more-likely-to-suffer-death-or-complications-if-operated-on-by-a-man

It would be interesting to see what surgeries were performed.

Its in the article:

The records included 25 different surgical procedures on the heart, brain, bones, organs and blood vessels.

And yet surgical training is still so tortuous that only 10-20 per cent of surgical trainees in the U.K. are women.

My guess would be that it’s being caused by a googled old fashioned dollop of sexism.

Thst when women apply to be surgeons, apply for senior positions etc they have to be excellent to be accepted whereas an average man is accepted for the same position.

So, you get fewer women in these posts, and the ones who are are exceptional. All of the merely good women have lost out along the way to mediocre men.

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.

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.

Differences in technique, speed and risk-taking suggested as reasons for surgery by men leading to more problems

As those doing the research suggested this was the problem you would think they would address this.

Not just brush it off as though it was a trait with silly remark like "lonesome cowboy"

And here we all are wondering why things never change.

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

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.

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.

Hello? Not sure why everyone wants to put so much effort into denying it could be true.

The report makes it clear they are comparing like for like. And even if for some reason the study included more operations by men, they the good or bad outcomes would be recorded as % in relation to that number, ditto the operations by women.

Added to which is the earlier report that women operated on by women have better outcomes.

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.

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.

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.

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.

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.

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 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.

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

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.

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

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.

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?

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.

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