Risks
Women who are operated on by a male surgeon are much more likely to die, experience complications and be readmitted to hospital than when a woman performs the procedure, research reveals.
Women are 15% more liable to suffer a bad outcome, and 32% more likely to die, when a man rather than a woman carries out the surgery, according to a study of 1.3 million patients.
Yikes. I wonder what would even explain that.
The findings have sparked a debate about the fact that surgery in the UK remains a hugely male-dominated area of medicine and claims that “implicit sex biases” among male surgeons may help explain why women are at such greater risk when they have an operation.
…
“On a macro level the results are troubling. When a female surgeon operates, patient outcomes are generally better, particularly for women, even after adjusting for differences in chronic health status, age and other factors, when undergoing the same procedures.”
Hmm maybe that hints at an explanation – women have to be better at it to get in the door at all. Good-enough men get to be surgeons but women have to be spectacular. Except no, because it’s only women who have worse outcomes; men do the same no matter what the sex of the surgeon.
Scarlett McNally, who has been a consultant orthopaedic surgeon for 20 years, said there was “increasing evidence of a different experience for women surgeons, with many being put off surgery and reporting historical ‘microaggressions’”. In addition, female patients may feel more at ease talking to a female surgeon before the operation, including steps they should take to improve their chances of a good outcome, such as stopping smoking to help ensure a bone graft takes, she added.
If surgery is one of those occupations that promotes a kind of macho culture, that could make male surgeons that little bit more off-putting to women patients. What a dismal thought.
I have very little doubt that the average female surgeon is better than the average male surgeon, precisely because of the stupid macho culture that reaches near hazing in some places. That female surgeon is then also going to be less likely to be dismissive of concerns at any stage in the cycle from her patients, regardless of their sex. By contrast, there will be a segment of male surgeons who will not have the ability they would have required to make it if female, who will be far more inclined to disregard any information/feedback/complaints from their patients, and particularly for those patients who are female.
This study would suggest the second effect (better information) has a stronger influence than the first.
There are several well-defined differences in how disease presents differently between male and female, and the disease that concerns me personally is cardiac-related. The research on women’s health lags behind, for funding and other reasons. So I can imagine that the male surgeons may not be as diligent in seeking out information on how their female patients may differ on the particular “ectomy” they are performing, while a female surgeon with a vested interest in the differences will be more careful to monitor the patient while operating specific to the sex of the patient.
If a surgeon doesn’t take the time to investigate sex differences, they may even perform the wrong type of surgery. Symptoms in males may call for a bypass while for a woman the same symptoms may call for an angioplasty, for example.
As a retired surgeon I can offer a couple of thoughts. When I was teaching residents I used to tell them that we didn’t have a healthcare system but rather a methodology for treating middle-aged white guys. Much of the medical literature of my formative years described signs in symptoms in men predominantly. One of my proudest moments was when an AI system I was developing identified a variant presentation of a deadly condition in a woman because it recognized the significance of sex and ethnicity in disease and injury presentation.
I also told the residents that if men had to carry a fetus to term our species would be long extinct. Despite the cliches associated with such things, women in both my experience and the literature, tend to have much higher tolerances for symptoms like pain. Higher tolerance can lead to diagnostic delays which lead to more advanced disease and hence higher mortality.
Also, up until recently, many women had their symptoms pooh-poohed as well which lead to the same delays and consequences.
[…] a comment by Pliny on […]
I could tell tales which could fill a book. Suffice it to say, I have met enough male surgeons with a god complex that I never want to meet another one in my life; which could have been a lot shorter, due to incompetent and stubborn, short-sighted egotistical male consultants.
Fortunately, there were enough decent men and awesome women to pick up the pieces and put me back together again. The younger generation of doctors seems to be coming along nicely.
I thought it was kind of odd how they dance around who has worse deaths, readmissions, and complications overall. It turns out men do, in every single subcategory, usually in the 40% – 50% range. See table 2 in the full text:
https://www.researchgate.net/publication/356887012_Association_of_Surgeon-Patient_Sex_Concordance_With_Postoperative_Outcomes#read
For example, for general surgery death rates (using doctor-patient) we have
Male-male: 0.9%
Male-female: 0.6%
Female-male: 0.8%
Female-female: 0.5%
They are? Not in that table. I just picked general surgery because it was first. All 9 subcategories are the same, with men having always higher and usually much higher death rates. The same for complications and readmissions.
The conclusions are clear:
– Women are much better doctors than men.
– Both male and female doctors have an implicit pro-female, anti-male bias, causing women to get significantly better results from both categories.
– This bias is somewhat stronger in female doctors, causing a larger gap in female-to-male outcomes than is seen with the male doctors.
Won’t somebody please think of the poor men? ;)
For the record, I had a winking emoji after the last sentence that WordPress decided to strip off. (And here I’d have a sad emoji but WordPress would probably just strip that off, too.) :(
I used the vast powers bestowed on me to override WordPres’s stripping.
Oh, yeah, I guess I could kick it old school (as the kids said 30 years ago) with emoticons.
Anyway, thanks.
Oh you mean the fancy kind. Well obviously those aren’t allowed. This isn’t The Plaza.
Irene Cybulsky applied successfully to McMaster [in Hamilton, Ontario] in cardiovascular and thoracic surgery, a specialty in which only 2.7 per cent of surgeons were women, where she suffered from discrimination as a woman surgeon.
A difficult story to read:
Christina Frangou “The Only Woman in the Room” December 20, 2021
https://torontolife.com/city/irene-cybulsky-surgeon-fired-for-being-female-hamilton-general-hospital/?utm_source=pocket-newtab
The Human Rights Tribunal of Ontario, wrote. “Her dignity and self-worth were undermined, and those consequences are directly connected to the fact that the applicant is a woman.” It concluded that Cybulsky’s rights were breached three times.
Cybulsky graduated with her law degree in June of 2020, finally answering the question she and her husband used to laugh about—what takes longer: a human rights tribunal claim over gender discrimination, or law school? The answer is the former, by about nine months.