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Societal Preferences for Gender of Surgeons: A Cross-Sectional Study in the General Population of Pakistan

Abstract

Background

Sociocultural norms and gender biases may result in surgeon gender preferences among the general public. This study aimed to understand preferences and perceptions related to surgeon gender among the general population in Pakistan, a lower-middle-income country.

Methods

A cross-sectional study was conducted by the Aga Khan University, Karachi, among the adult general population in Pakistan. Sequential mixed-mode data collection was performed via online dissemination on social media platforms and in-person surveying at different geographic locations in Karachi.

Results

Among 1604 respondents, 50% did not report having surgeon gender preferences in general. Among respondents with gender preferences, there was a highly significant preference for gender concordance across all surgical subspecialties (p <0.001) except cardiothoracic surgery and neurosurgery. Exceptions where women preferred a male surgeon were neurosurgery (59.7% vs. 40.3%; p <0.001) and cardiothoracic surgery (53.1% vs. 46.9%; p <0.001). Moreover, respondents felt more comfortable communicating with (67.6%) and being examined by (73.3%) gender concordant surgeons. Men more commonly perceived male surgeons as more competent (26% vs. 14.5%; p <0.001) and warmer (18.3% vs. 9.8%; p <0.001) than female surgeons. Nevertheless, the most important factors influencing selection of a surgeon were the surgeon’s reputation (69.6%) and experience (50.5%). Most respondents (84.5%) believed that more females should practice surgery.

Conclusion

While around half of respondents do not have gender preferences, a significant proportion prefers a gender concordant surgeon across subspecialties. In a society where conservative sociocultural norms play a significant role when seeking health care, this makes yet another compelling argument for gender parity in surgery.

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Fig. 1

References

  1. Steinhausen S, Ommen O, Thüm S, Lefering R, Koehler T, Neugebauer E et al (2014) Physician empathy and subjective evaluation of medical treatment outcome in trauma surgery patients. Patient Educ Couns 95(1):53–60

    Article  Google Scholar 

  2. Kim SS, Kaplowitz S, Johnston MV (2004) The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof 27(3):237–51. https://doi.org/10.1177/0163278704267037

    CAS  Article  PubMed  Google Scholar 

  3. McLafferty RB, Williams RG, Lambert AD, Dunnington GL (2006) Surgeon communication behaviors that lead patients to not recommend the surgeon to family members or friends: analysis and impact. Surgery 140(4):616–624

    Article  Google Scholar 

  4. Axelrod DA, Goold SD (2000) Maintaining trust in the surgeon–patient relationship: challenges for the new millennium. Arch Surg 135(1):55–61. https://doi.org/10.1001/archsurg.135.1.55

    CAS  Article  PubMed  Google Scholar 

  5. Ambady N, LaPlante D, Nguyen T, Rosenthal R, Chaumeton N, Levinson W (2002) Surgeons’ tone of voice: a clue to malpractice history. Surgery 132(1):5–9

    Article  Google Scholar 

  6. Cejka MA, Eagly AH (1999) Gender-stereotypic images of occupations correspond to the sex segregation of employment. Pers Soc Psychol Bull 25(4):413–423. https://doi.org/10.1177/0146167299025004002

    Article  Google Scholar 

  7. Delgado A, López-Fernández L-A, de Dios Luna J, Saletti-Cuesta L, Gil N, Jiménez M (2011) The role of expectations in preferences of patients for a female or male general practitioner. Patient Educ Couns 82(1):49–57

    Article  Google Scholar 

  8. Nicolai J, Demmel R (2007) The impact of gender stereotypes on the evaluation of general practitioners’ communication skills: an experimental study using transcripts of physician–patient encounters. Patient Educ Couns 69(1):200–205

    Article  Google Scholar 

  9. Eagly AH (2013) Sex differences in social behavior: a social-role interpretation. Psychology Press

    Book  Google Scholar 

  10. Rudman LA, Phelan JE (2008) Backlash effects for disconfirming gender stereotypes in organizations. Res Organ Behav 28:61–79

    Google Scholar 

  11. Phelan JE, Rudman LA (2010) Prejudice toward female leaders: backlash effects and women’s impression management dilemma. Soc Pers Psychol Compass 4(10):807–820

    Article  Google Scholar 

  12. Eagly AH, Karau SJ (2002) Role congruity theory of prejudice toward female leaders. Psychol Rev 109(3):573

    Article  Google Scholar 

  13. Abghari MS, Takemoto R, Sadiq A, Karia R, Phillips D, Egol KA (2014) Patient perceptions and preferences when choosing an orthopaedic surgeon. Iowa Orthop J 34:204

    PubMed  PubMed Central  Google Scholar 

  14. Dineen HA, Patterson JMM, Eskildsen SM, Gan ZS, Li Q, Patterson BC et al (2019) Gender preferences of patients when selecting orthopaedic providers. Iowa Orthop J 39(1):203–210

    PubMed  PubMed Central  Google Scholar 

  15. Franklin A, Carrico CK, Laskin DM (2017) Societal preference for gender of surgeons performing patients’ surgery. J Oral Maxillofac Surg 75(3):458–461

    Article  Google Scholar 

  16. Huis in’t Veld EA, Canales FL, Furnas HJ (2017) The impact of a plastic surgeon’s gender on patient choice. Aesthet Surg J 37(4):466–71

    Google Scholar 

  17. Chitguppi C, Brar T (2018) Do otolaryngology patients show gender preference when choosing a surgeon?—a quantitative and qualitative analysis. Int Arch Otorhinolaryngol 22(4):404–407

    Article  Google Scholar 

  18. Rizk DEE, El-Zubeir MA, Al-Dhaheri AM, Al-Mansouri FR, Al-Jenaibi HS (2005) Determinants of women’s choice of their obstetrician and gynecologist provider in the UAE. Acta Obstet Gynecol Scand 84(1):48–53

    Article  Google Scholar 

  19. Inam H, Janjua M, Martins RS, Zahid N, Khan S, Sattar AK et al (2020) Cultural barriers for women in surgery: how thick is the glass ceiling? An analysis from a low middle-income country. World J Surg 44:2870–2878

    Article  Google Scholar 

  20. Malik M, Inam H, Janjua MBN, Martins RS, Zahid N, Khan S et al (2021) Factors affecting women surgeons’ careers in low–middle-income countries: an international survey. World J Surg 45(2):362–368

    Article  Google Scholar 

  21. Martins RS, Hashmi SA, Inam H, Janjua M, Malik M (2021) Harassment and mental health in surgical training: a pilot survey of surgical trainees in Pakistan. JPMA J Pak Med Assoc 71(1 (Suppl 1)):S23

    PubMed  Google Scholar 

  22. Janjua MB, Inam H, Martins RS, Zahid N, Sattar AK, Khan SM et al (2020) Gender discrimination against female surgeons: a cross-sectional study in a lower-middle-income country. Ann Med Surg 57:157–162

    Article  Google Scholar 

  23. Starr CR, Zurbriggen EL (2017) Sandra Bem’s gender schema theory after 34 years: a review of its reach and impact. Sex Roles 76(9):566–578

    Article  Google Scholar 

  24. Braun HJ, O’Sullivan PS, Dusch MN, McGrath MH, Ascher NL (2017) The roles of gender and demeanor in perceptions of female surgeons. Arch Psychol. https://archivesofpsychology.org/index.php/aop/article/view/25

  25. Halim NA, Beaineh P, Fenianos M, Gebran S, Msheik A, Sharara S et al (2020) Preferences of Lebanese adults for the gender of their surgeons: a cross-sectional study. East Mediterr Health J 26(5):573–579

    Article  Google Scholar 

  26. Pilz M, Stummer W, Holling M (2020) Neurosurgery in contemporary medical dramas: How Grey’s Anatomy & Co. may affect perception of neurosurgery in the media. J Neurol Surgery Part A Cent Eur Neurosurg 81(06):495–500

    Article  Google Scholar 

  27. Motiwala M, Ajmera S, Akinduro O, Wallace D, Norrdahl SP, Schultz A et al (2019) How does the media portray neurosurgeons? World Neurosurg 122:e598-605

    Article  Google Scholar 

  28. Flores G (2002) Mad scientists, compassionate healers, and greedy egotists: the portrayal of physicians in the movies. J Natl Med Assoc 94(7):635

    PubMed  PubMed Central  Google Scholar 

  29. Logghe H, Jones C, McCoubrey A, Fitzgerald E (2017) #ILookLikeASurgeon: embracing diversity to improve patient outcomes. BMJ. https://doi.org/10.1136/bmj.j4653

    Article  PubMed  Google Scholar 

  30. Childs AJ, Friedman WH, Schwartz MP, Johnson M, Royek AB (2005) Female patients’ sex preferences in selection of gynecologists and surgeons. South Med J 98(4):405–409

    Article  Google Scholar 

  31. Schmittdiel J, Selby JV, Grumbach K, Quesenberry CP (1999) Women’s provider preferences for basic gynecology care in a large health maintenance organization. J Women’s Health Gender-Based Med 8(6):825–33

    CAS  Article  Google Scholar 

  32. Johnson AM, Schnatz PF, Kelsey AM, Ohannessian CM (2005) Do women prefer care from female or male obstetrician-gynecologists? A study of patient gender preference. J Am Osteopat Assoc 105(8):369–379

    Google Scholar 

  33. Tempest HV, Vowler S, Simpson A (2005) Patients’ preference for gender of urologist. Int J Clin Pract 59(5):526–528

    CAS  Article  Google Scholar 

  34. Cil TD, Easson AM (2018) The role of gender in patient preference for breast surgical care—a comment on equality. Isr J Health Policy Res 7(1):1–3

    Article  Google Scholar 

  35. Wynn J, Johns PL (2021) Patient preference for urologist gender. Int J Urol 28(2):170–175

    Article  Google Scholar 

  36. Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA et al (2016) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth 25:75–78

    Article  Google Scholar 

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Acknowledgements

We would like to acknowledge the Research and Development Wing of the Society for Promoting Innovation in Education at the Aga Khan University for providing valuable research mentorship to author Syeda Maryam Zehra Zaidi.

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Correspondence to Mahim Akmal Malik.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted in accordance with all ethical principles outlined in the 1964 Declaration of Helsinki and its future amendments. The institutional review board at the Aga Khan University reviewed and approved the protocol of this study.

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Informed consent was obtained from all respondents.

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Martins, R.S., Gillani, M., Jawaid, S. et al. Societal Preferences for Gender of Surgeons: A Cross-Sectional Study in the General Population of Pakistan. World J Surg 46, 757–766 (2022). https://doi.org/10.1007/s00268-021-06418-4

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  • DOI: https://doi.org/10.1007/s00268-021-06418-4