Patients with female doctors have better survival rates and suffer fewer complications - Joanna Wane

US actor Elizabeth Banks plays a gifted surgeon under fire in A Mistake at the New Zealand International Film Festival, an adaptation of Wellington writer Carl Shuker's 2019 novel.

THREE KEY FACTS

• A new study of more than 700,000 patients found those with a female doctor were less likely to die or be readmitted to hospital within 30 days.
• Women have a higher risk of mortality and poor outcomes if their surgeon is male.
• After a patient’s death, referrals to male surgeons increase while female surgeons receive fewer and for less complex procedures.

Joanna Wane is an award-winning senior feature writer with a special interest in social issues and the arts.

OPINION

The latest international research showing better survival rates and a lower chance of readmission for hospital patients under the care of a female doctor comes as no surprise to Kiwi surgeon Ineke Meredith.

It’s a well-documented phenomenon she wrote about in her best-selling memoir On Call, which came out earlier this year.

She told the Herald it makes her laugh when people suggest the explanation might be that female surgeons are simply more empathetic. “Maybe they’re just better!” she says.

“If it was reversed and the studies showed men had better outcomes, we would conclude that male surgeons are technically better than female surgeons. Why do we not say the same for women?”

One of the studies she quotes in On Call, published in the British Medical Journal in 2017, looked at death or complication rates after an operation and found patients were less likely to die within 30 days if their surgeon was a woman.

The decrease was small but considered statistically significant. What that means, explains Meredith, is that “the result is true and almost certainly not owing to chance”.

An even more intriguing 2022 study by the University of Toronto analysed outcomes across 21 common surgical specialities, ranging from cardiac and orthopaedics to appendectomy and gastric bypass.

That analysis showed female patients treated by a male surgeon had a higher risk of mortality and poor outcomes compared to female patients operated on by a female surgeon. Male patients had comparable outcomes whatever their surgeon’s gender.

The latest Japan-US study, which involved more than 700,000 patients aged 65-plus, identified the same pattern, with patients - and particularly female patients - less likely to die or be readmitted to hospital within 30 days of discharge if they were under the care of a female doctor.

According to the research team at the University of California, Los Angeles (UCLA), closing that gap could save the lives of up to 5000 women a year.

In an attempt to explain the findings, the team’s report speculates that female doctors may provide better care because they have superior communication skills and are more likely to take patient concerns seriously.

A previously published Harvard paper found male GPs tended to engage with patients more briefly and interrupt them more often – especially if they were women. Another US study found female patients were more likely to die of a heart attack when treated by a male doctor.

Meredith, who specialised in general surgery and breast reconstruction for cancer patients, now lives in Paris, although she’s still actively involved in research projects on cancer inequities here.

On Call, a memoir by Samoan/New Zealand surgeon Ineke Meredith, highlights multiple studies showing better outcomes for patients who have a female doctor or surgeon.

She agrees communication is important – although, ironically, one published paper found patients were more likely to be happy with a male doctor who demonstrated empathy, while they were less impressed with an empathetic female GP.

However, she also reckons the way male and female surgeons train is very different. “If you take a male surgical trainee and show him something once, he’ll think he’s ready to do the surgical procedure independently,” she says, acknowledging this is a broad generalisation that’s difficult to measure.

“If you take a female surgical trainee, she will want you to show her 10 times, and then be in the room with her when she finally does it on her own. Could it be that this self-imposed demand for excellence – let’s not call it lack of self-confidence anymore – is the reason for these differences in surgical outcomes?”

While there’s now an even gender split in New Zealand when it comes to entering both medical school and surgical training, ingrained bias still exists. Fewer women become specialists and it seems they still have more to lose.

A Harvard research paper found that after a patient’s death, the perception of a female surgeon’s skill and ability was significantly undermined for the next 18 months, as evidenced by fewer referrals and for far less complicated procedures, while male surgeons received more referrals than they had in the same period before the patient died.

“The magnitude of difference was such that a male surgeon experienced three patient deaths before he had the same reduction in referrals as a female surgeon after one death,” writes Meredith in On Call.

Wellington novelist Carl Shuker skewers gender bias in his novel, A Mistake, where a gifted female surgeon is scapegoated by hospital management.

Who should be held to account for the death of a young woman after an error is made during surgery is at the heart of a new film by Kiwi director Christine Jeffs (Rain, Sylvia, Sunshine Cleaning) screening at the New Zealand International Film Festival, which opens next month.

It’s adapted from the 2019 novel A Mistake, an Ockham award finalist by Wellington writer Carl Shuker, and stars US actor Elizabeth Banks (Pitch Perfect, The Hunger Games) as a gifted surgeon hung out to dry by patronising male bureaucrats more concerned with the hospital’s reputation than genuine accountability.

When he wrote the book, Shuker was working as an editor at the British Medical Journal, at a time when the UK had begun publishing the outcomes of individual surgeons in the name of greater transparency – an issue that remains polarising today.

Liz, the somewhat abrasive main character, is polarising too, with some finding her unlikeable – a trait that seems expected of women in powerful positions (such as politics) but remains essentially irrelevant in men.

Shuker deliberately placed Liz in a male-dominated system and says he has no doubt her gender influences the way readers react to her. “As a man, she would have been seen as driven, no-nonsense, and afforded instant respect.

“As a woman, she’s still having to fight the fight of even being recognised, let alone trusted and respected, as a surgeon.”