Patient’s preference regarding the demographic and clinical characteristics of their health care provider may affect health needs, satisfaction and quality of life. In comparison with other possible factors, gender preference is likely to have a stronger impact when choosing health professionals engaged in intimate and psychosocial medical treatment. Indeed, several previously published studies found that women tend to prefer female physicians, especially when it comes to obstetrical/gynecological issues [1, 2, 12, 13]. Data regarding other intimate specialties such as breast surgery are scarce. Results of the present study show that overall about a third of female patients prefer a female breast surgeon. Interestingly, patients exhibited more same-gender preference for breast examination (32 %) than for breast surgery (14 %), or any other surgery (7 %).
Same-gender preference for health care providers was previously reported in up to 35 % of patients [14–16]. Several studies investigated women's preference for the gender of their gynecologist-obstetrician, however, only one previously published study (from almost 20 years ago) investigated patients' gender preference for breast surgeons: In 1997 a female surgeon joined a British specialist breast clinic, which had previously been run by a male surgeon [6]. One hundred consecutive newly referred patients were asked to fill in an anonymous questionnaire regarding their preferences for female or male breast surgeons, and 31 of these preferred a female surgeon. The most striking finding was that none of the women preferred a male surgeon. Patients who preferred a female surgeon were younger than women with no preference. Women who stated a preference for a female surgeon made comments such as “women are easier to talk to” and “I feel less embarrassed with a woman.” Patients who had no preference felt that a surgeon's gender did not affect competence and that the most important issue was to have a good surgeon irrespective of gender.
Results of the present Israeli study, performed 18 years later, are similar to those of the earlier British study: overall, 28.2 % of our patients preferred a female breast surgeon, 61 % had no gender preference, and only 10.8 % preferred a male breast surgeon. Embarrassment during the examination was the major reason for same-gender preference. This finding is also supported by other studies among male and female patients that found embarrassment as one of the major reason for same-gender preference [3, 4].
A multiple regression analysis showed that the preference for a female breast surgeon was significantly and independently associated with younger age of the patients and their marital status. These results are supported by a Greek study that demonstrated correlations between marital status and age to same-gender preference of women for their gynecologist [17]. Results also show that about half of women who were previously exposed to female surgeons preferred female breast surgeons, implying that responder’s experience with female surgeons was positive.
Moreover, the Israeli population is composed of several sub-populations with different demographic, religious and social characteristics that may influence the preference of a same-gender health care provider. We have previously studied gender preferences for obstetricians and gynecologists among communities such as Orthodox Jews [18], Muslim Israeli-Arab women [1], and Israeli Druze women [2] where religiousness and modesty are deeply rooted. All three studies have demonstrated a clear preference for female obstetricians and gynecologists, with the overwhelming reasons given being feeling more comfortable and less embarrassed with females, and the notion that female obstetricians and gynecologists are more gentle during intimate procedures. Similarly, results of the present study demonstrated the same preferences with regard to breast and physical examinations. This implies that women prefer examinations by female surgeons because a) they perceive them to be more gentle/sensitive than male surgeons and b) simply because they are women. Interestingly, although Muslim Israeli-Arab women preferred female obstetricians and gynecologists, personal and professional skills were found to be more important factors when it came to actually making a choice. The current study was not designed to detect statistically significant differences among these ethnic subgroups, however, results show a similar trend for preference for a female breast surgeon among Orthodox Jews (33 %) and Muslim Israeli-Arab women (44 %).
We also investigated gender preference for non-invasive versus invasive surgical procedures. Significantly more patients preferred to undergo breast examination by a female surgeon than a male surgeon (32 % versus 9 %, respectively). Interestingly, there was almost no difference between breast examination (32 %) and general physical examination (26 %), however our study was not powered to detect such a difference. On the other hand, with regard to breast surgery most patients (73 %) had no gender preferences and only a small number of patients preferred a female (14 %) or a male (13 %) surgeon. These findings imply that many women prefer female doctors for intimate physical examination, however, when an invasive surgical procedure with a potential health threat is required, professional skills of the surgeon are more important than his/her gender per se. There are at least two important distinctions between breast examination and breast surgery: the degree of risk and the extent to which the patient is conscious and interacting with the physician, and hence subject to embarrassment. Further studies are required to explore the relative contribution of these factors to the difference in preference for a female surgeon. Moreover, further analysis confirmed that the most important parameters for the responders regarding their overall choice of a breast surgeon were professional skills, such as surgical ability, experience and knowledge. Similarly, other studies among modern and western communities found physician’s professionalism rather than gender as the most important preference factor [19–21].
