New research released last week suggests that sex matters when it comes to surgery. Researchers examined the sex of the surgeon and the sex of the patient in over a million surgeries and found that female patients with male doctors fared slightly worse than any other combination. The reason for the disparity likely comes down to communication and relationship-building.
The study, published in JAMA Surgery, examined 1,320,108 surgeries conducted on adults in Ontario, Canada from 2007 to 2019. The researchers controlled for variables that might matter like the type of surgery, age of the patient and patient’s comorbidities, as well as information about the surgeon like how long they have been practicing and the number of surgeries performed each week. They even controlled for variables relating to the hospital where the surgery was performed. All in all, female patients with male surgeons were 1.15 times more likely than female patients with female surgeons to have complications (including death) in the thirty days following the study. Men with male surgeons had similar outcomes to men with female surgeons.
Why the disparity in treatment? Although the study itself did not examine potential causes for the disparate treatment, the study authors suggest a couple of possibilities. One is that the physician-patient relationship is not as strong when the sex of the patient differs from the sex of the physician. In fact, the physician-patient relationship suffers the most when female patients interact with male physicians. In addition, prior research “suggests an underappreciation for the severity of symptoms in female patients, particularly among male physicians. However, work has also shown that patients may report less postoperative pain to male assessors,” the authors write.
Similar research which examined race suggested better outcomes occurred when the race of the physician and the patient matched. Once again, a better physician-patient relationship is likely what drives this outcome. “The patient-physician relationship is strengthened by a shared identity, which may be driven by sex, race and ethnicity, or other personal beliefs and values,” the authors write. And when patients perceive themselves as similar to the physician, they are more likely to adhere to treatment recommendations.
One strategy to overcome these barriers and help patients perceive themselves as similar to their physicians, is the physician’s use of patient-centered communication styles. A patient-centered approach to communication has been defined as acknowledging “the whole person, their personality, life history, and social structure in order to develop a shared understanding of the problem, the goals of treatment, and the barriers to that treatment and wellness.” According to research, female physicians are more likely to adopt a patient-centered communication strategy. This may be why male patients with female physicians did not suffer worse outcomes in the JAMA study.
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Of course, no discussion on sex and surgery can be complete without acknowledging the scarcity of female surgeons. In an invited commentary on the JAMA Surgery research, Andrea Riner, MD, MPH and Amalia Cochran, MD wrote, “the elephant in the room is the paucity of female surgeons.” They point out that in 2019, only 22% of general surgeons in the United States were women. And some fields like orthopedic surgery had dramatically lower representation of women (5.8%). This difference persists despite the fact that women currently outnumber men in medical school. “Efforts to recruit women into surgery need to be ramped up,” Riner and Cochran write. They add, “It is not just about equity among surgeons; there is a growing body of evidence that this is also good patient care.”