“She is a nut. What else do you expect?”
This is someone talking to me during my surgery residency in JIPMER, Pondicherry. The object of his judgement was a woman surgical resident.
In Medical College, Thrissur, where I did my MBBS, there were precisely zero number of women Surgeons. A female orthopaedic surgeon was an unthinkable oddity, like a unicorn with wings.
When I reached JIPMER and Surgery there, I found, to my surprise, that there were three or four of these strange beings, existing- sort of. As natural as fish grazing in an African savanna. It was tough for them. It was ‘generally accepted’ that they were:
- Somehow abnormal
- Generally incompetent.
It was conceded, generously, that there were exceptions to the rule.
Oh. I would have liked to don the pious cap, or occupy the moral high hill and say that I saw through this miserable injustice. No. I am not saying more. I plead terribly guilty.
A few years after, I had become a faculty in an academic setting. I noticed that suddenly, medicine was overrun with women. Surgery too.
Right now, more than half of our residents are women. I am always struck by how good most of them are.
Recent studies seem to suggest that female surgeons may actually be BETTER (!) than male surgeons.(1,2, 3,4). The largest and most recent(1) has huge numbers. Well over a million patients, over 1000000 Male surgeons and about 150000 Female surgeons examined in a retrospective cohort format. Some earlier studies had already established that Female surgeons are just as good as males.(5,6)
“After accounting for patient, procedure, surgeon, anesthesiologist, and hospital characteristics, the findings of this cohort study suggest that patients treated by female surgeons have lower rates of adverse postoperative outcomes including death at 90 days and 1 year after surgery compared with those treated by male surgeons.”(1)
“female physicians adhere to guidelines more closely, use more patient-centered communication, are more willing to collaborate, and select patients for planned surgery more carefully.”(4)
“female students respond better to instructor feedback in virtual reality simulator training.”(4)
It does call for some introspection. Female Surgeons are slower(1,4). They communicate better, collaborate, and adhere to protocols. They are sensitive to feedback. The effect sizes are not huge, but is significant.
The era of the brash, fast, testosterone powered, egoist surgeon could be getting over. Overconfidence is dangerously overrated. A careful, thoughtful surgeon maybe better. We need to re think the paradigms that we are currently enmeshed in.
We are making progress.
- Wallis CJ, Jerath A, Aminoltejari K, Kaneshwaran K, Salles A, Coburn N, Wright FC, Conn LG, Klaassen Z, Luckenbaugh AN, Ranganathan S. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA surgery. 2023.
- Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. Bmj. 2017 Oct 10;359.
- Almquist M. Are Women Better Surgeons Than Men?. JAMA surgery.
- Blohm M, Sandblom G, Enochsson L, Österberg J. Differences in cholecystectomy outcomes and operating time between male and female surgeons in Sweden. JAMA surgery. 2023 Aug 30.
- Okoshi K, Endo H, Nomura S, Kono E, Fujita Y, Yasufuku I, Hida K, Yamamoto H, Miyata H, Yoshida K, Kakeji Y. Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study. bmj. 2022 Sep 28;378.
- Sharoky CE, Sellers MM, Keele LJ, Wirtalla CJ, Karakousis GC, Morris JB, Kelz RR. Does surgeon sex matter?: practice patterns and outcomes of female and male surgeons. Annals of surgery. 2018 Jun 1;267(6):1069-76.