LAUSR

Over the last 50 years, there has been an awakening to the truth that all human beings, regardless of their gender identity, are created as equals. I say 50 years because, to me, that coincides with a real call for action (often referred to as the gender revolution) towards equal opportunity at the work place for every individual regardless of their gender [1]. This revolution appears to have gained more traction only recently, and we should be proud to be living in these progressive times where we have the opportunity to support the change for good. Surgery, in general, has been a medical specialty where the ability to achieve gender equity, let alone gender equality, has been challenging [2]. The reasons for this are multifactorial and may include conscious and unconscious gender bias, the lack of appropriate role models, and the lack of consideration for care-giving responsibilities both in training and in postgraduate practice [3]. A factor, often ignored, when considering the problem of gender equity in medical professions is societal preferences. The study by Martins et al. [4] from Pakistan provides a bold initial step to enlighten the global readership of the World Journal of Surgery about this additional factor that significantly impacts the progress of gender equity. In their study, Martins et al. [4] not only used standard online platforms (including Facebook , Twitter , and Instagram ) to administer their survey (in English and Urdu) seeking to understand preferences and perceptions related to surgeon gender to adults in Pakistan, they also ensured that the survey was presented to individuals of all economic strata using 15 data collectors to survey people who did not have access to the internet in the metropolitan city of Karachi. Thus, the survey may have not included a sufficient rural representation (as highlighted as a limitation by the authors); however, it is still relevant in terms of gathering important pilot data to inform future endeavours of this kind. Respecting cultural sentiments, the authors ensured an adequate mix of male and female data collectors. The results based on the responses of 1604 respondents were telling. Not unexpectedly, there was a significant preference for gender concordance across all surgical subspecialties, including the opportunity to communicate with, or be examined by, doctors of the same gender. However, both male and female respondents preferred male cardiothoracic and neurosurgeons. The respondents understandably placed overall importance on the reputation and experience of the surgeon, regarding men as more competent. More importantly, nearly 85% of people supported the notion of women practicing surgery. The results of this survey provide a unique peek into socio-cultural factors influencing gender equity in surgery. The progressive responses largely reflect the fact the survey was conducted in metropolitan Karachi. Societal, and patient, preferences regarding the gender of their surgeon may be less of an issue in developed countries. However, in developing nations they play an important role. Speaking from personal experience, I have witnessed the ‘‘hidden’’ pressures on young women to conform to roles that are family-oriented and gender-concordant, and while some families may be progressive and supportive, many are not. This in itself may contribute to some of the patient preferences observed. & Savio George Barreto [email protected]; [email protected]