Inter Gender Tic Tac Toe

The paper entitled Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries published in JAMA has stimulated much conversation worldwide.

Much needs to be done to promote female surgeons, who may have to overcome greater challenges in their career progression. Recent alarming reports form the UK indicate that workplace harassment is an all-too-common experience for female surgeons unfortunately.

The president of the Royal College of Surgeons of England, Tim Mitchell had to apologise regarding comments he made in reference to this paper and a further paper assessing the outcome of cholecystectomies. The paper’s message that female surgeons perform better than their male colleagues has some potential benefits. Expanding the female surgical workforce, through increasing the pool of those seeking to peruse a surgical career, would likely improve the overall care that patients receive.

It may also be tempting to conclude that finally we have evolved, we have equality, we are redressing the wrongs of the past and all is well in the medical firmament.

We ask then if it is possible to comment on this paper without facing a backlash?

So, without commenting on this paper, proceeding as dispassionately as possible, yet fully expecting to be cancelled, we make the following general comments regarding the consequences of such studies.

There is danger in overemphasising nature versus nurture, as addressing inequalities in healthcare access and training, to improve outcomes for as many patients as possible is of greater benefit. The variability in outcome amongst male and female surgeons is much greater than the potential differences between genders.

This paper has made headlines worldwide; however, the findings of this paper may be pertinent to a specific time and place and global extrapolation of findings may not be meaningful, when there are many variations in training, culture, gender roles and disease presentations. Such a generalised interpretation of findings is purely siding with nature, as the nurturing of surgeons cannot be the same worldwide.

An unwelcome consequence of such studies is that patients may feel that their operation has been compromised on the ground of the gender, or any other demographic detail of their surgeon.

Surgery is no game, but if you can humour us by considering a game analogy; it would be possible to obtain a representative worldwide sample of male and female players of Tic Tac Toe, darts, who wants to be a millionaire or any other skill-based game, weighted according to the number of players in each country, to determine whether men or women were better at any of these games. We are not aware that any game association has undertaken such a contest, preferring instead to find individual champions and we suspect there would not be much public interest in such offerings.

It is unlikely that a randomised trial well ever be conducted to test the hypothesis that one gender performs better than another at surgery, so we will likely never know the answer, but do we need an answer? What does it mean and are the consequences beneficial to patients or an unnecessary impediment to care and diversion from more pressing health issues.

Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries