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Dr. Wallis discusses future work exploring surgeon gender and patient outcomes

Opinion
Video

“What we're thinking here is that surgeon sex is a surrogate for a whole series of behaviors driven by sociologic conditioning of how people interact with each other and how physicians practice medicine,” says Christopher J.D. Wallis, MD, PhD.

In this video, Christopher J.D. Wallis, MD, PhD, discusses future research based on the study, “Surgeon sex and long-term postoperative outcomes among patients undergoing common surgeries,” for which he served as the lead author. Wallis is a urologic oncologist at Mount Sinai Hospital and University Health Network and an assistant professor of surgery at the University of Toronto in Toronto, Ontario, Canada.

Video Transcript:

The clear understanding is that epidemiologic data like this can just show an association; it doesn't tell us why things are the way they are. Presumably, it's not the presence of a Y chromosome that's leading to worse patient outcomes. What we're thinking here is that surgeon sex is a surrogate for a whole series of behaviors driven by sociologic conditioning of how people interact with each other and how physicians practice medicine. There's a lot of work planned and currently ongoing. We have further quantitative research like this, trying to capture differences in how physicians and surgeons are practicing. So, what we're doing differently before surgery, during surgery, and after surgery in the different aspects of care. We have a qualitative study ongoing. We have an anthropologist as part of our research team who is observing surgeons as they interact with their patients and make decisions around going for surgery and what surgery to undertake.

We're really looking to bridge that gap from an association showing differences to understanding why there's a difference. The ultimate goal here is not to have every patient undergo surgery by a woman surgeon; I don't think that's feasible. But instead, if we can understand what the differences in practice are, that allows us an opportunity to improve care from all surgeons. This is a teachable skill, hopefully, so all surgeons can improve the care they deliver and optimize their patients’ outcomes. That's the ultimate goal of all of this work is to get to a better understanding of what's driving these differences, such that we can all improve the care we deliver.

And anecdotally, I obviously am a male surgeon, and I think, doing this work, while I don't yet have the answer as to what's driving the differences, has changed the way I practice. Some of my colleagues have reacted to this data with a bit of defensiveness, and I've tried to approach it with a bit of introspection and say, "maybe there are differences, and maybe reliably, patients who have a female surgeon are doing better." If we think about what we know about how men and women practice medicine differently, maybe I can take some of those lessons into how I approach my patient care.

One of the key takeaways from one of our other studies was that there's an interaction between patient and physician sex. There's an effective discordance that may worsen outcomes. So, that's really highlighted for me the need to personalize patient counseling. In the context of, say, a robotic partial nephrectomy, you may be not approaching your counseling the same with all your patients, right? Younger patients and older patients may need different counseling. Patients may need different counseling based on their health literacy. Certainly, patients sex may come into those discussions as well. They may take in information differently and process it differently. I think all of these features are something that really warrant a bit of introspection in thinking about how we practice and how we can change our practices to optimize outcomes for our patients.

This transcription has been edited for clarity.

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