Healthcare systems in both developed and developing countries is facing gender discrimination in all fields that have a serious impact on health outcomes. The main source of this discrimination is the patient and their families as reported by 49.2% participants in a study.13 The main purpose of this survey was to assess gender preferences of medical personnel as patients or attendants while selecting ophthalmic surgeons for regular medical check-up or surgery and to highlight the factors responsible for this discrimination. The findings of our study are no more different from the previous studies while considering basic knowledge, surgical skill, communication style and patient doctor relationship in selecting gender of surgeon and physician in field of ophthalmology.
For regular medical check-ups and for various types of ophthalmic surgeries, major proportion of participants have no gender preference (about 50.2%) which means people have started accepting the reality that it’s the doctor which matters not the gender. However, in remaining participants who selected a preference and that was for males in majority (35.5%). Cataract surgery is most commonly performed surgical procedure in ophthalmology and for that, almost 41% participants had preference for male surgeons. According to Cai CX et al, male surgeons on average performs 276 cataract surgeries while female surgeons perform 140 cataract cases per year.14 Its mostly because of general perception of males being more skillful and having more practice in their career. This supports the male surgeon preferences for oculoplastic and vitreoretinal surgeries (39.4% and 50% respectively). For emergency cases 39% of the participants and for complicated cases 48% of them prefer male surgeons owing to their surgical expertise and attributes like being stronger and fearless. It was only for pediatric ophthalmology cases that female surgeons were preferred over male surgeons (33% versus 21%) and this was probably due to more females in pediatric ophthalmology and also that females are more affectionate and better dealing with kids. Wallis J D et al. exhibited that female surgeons have less postoperative complication (difference of 0.43%) because they performed surgeries on young patients with less comorbidities and most of the surgeries are elective in nature.15
Findings in our survey regarding attributes of female surgeons are consistent with previous researches. Alyaha et al. analyzed that females are better at understanding patient psychological factors (60%), good listener, exhibit rapport building behavior, and are cooperative with patients.16 Patient satisfaction is generally predicted by communication style and comprehension of problem from biopsychosocial aspect. 41.9% participants preferred female surgeons due to this attribute in another survey17 that is consistent with 44% in our survey. Lim et al.18 showed that 45% of participants think females are not less qualified than males which is comparable to our study finding (54%). Furthermore about 48.5% agree that females face difficulty in commanding authority, 29% thinks females have to work harder to establish their legitimacy and 36% believes in less workplace support to them. It is mainly due to trust of patients and hospital staff in male surgeons. This lack of respect can make them less passionate in their work and they have to work more masculine in male determined surgical field.19
In our study, male surgeons were preferred for being more confident, fearless, more experienced (52%), competent (50.5%), have better professional skill (56.1%), more decisive, have better credibilty than females and similar results were shown by another study by Alkhaldi et al.20 Owing to these qualities, male ophthalmologist are preferred for clinical practice more while females are likely to be employed by academic institutions (42.8% vs 30%).21 Another justified reason for giving the preference to male surgeons is because females are easily burn out at workplace because they have to keep balance between family life and professional life and also they usually face lack of support at workplace.22,23
In the light of above discussions, this study provides us valuable information regarding gender discrimination of ophthalmic surgeons and participants in our study are actually medical personnel who have sufficient surgical insight and working experience with ophthalmic surgeons. Thus, the data inferred from our study is more logical and reality based considering our effective sample population rather than patients who don’t have this much insight and their perceptions are more based on social believes.
The limitation of our study is that our study is based on single center and single specialty. Our future recommendations are multi-centered study involving multiple surgical fields and sample population being medical personnel as well as general population for more holistic approach towards this concept.