The Effect of Patients׳ Appearance on Doctors’ Diagnostic Decision Making: Do Poor People Get Poorer Medical Care?

Purpose Health inequalities are of great concern to health providers. Studies on the influence of social class on diagnostic performance are rare and inconclusive. We investigated whether patients’ appearance (poor versus rich) affects physicians thinking and their ability to reach a correct diagnosis. Method Forty-six internal medicine residents participated in this purposely designed computerized study. Every participant solved four case scenarios with one of two versions of a patient׳s picture for each scenario. In this study simulated patients’ pictures were used to play the role of poor and dirty patients in one condition and rich and clean in another condition. The basic analysis was aimed at diagnostic accuracy. Time needed to reach a decision and participants’ ratings of how extensively they had processed the case, the latter composed by ratings of confidence in the diagnosis, case complexity and mental effort required to diagnose the cases, were measured for each participant and used as indications of the extent to which participants diagnosed the case analytically. Results There were no significant differences between the two conditions in terms of diagnostic accuracy and time spent in diagnosing the cases. However, even if the cases were exactly the same, participants reported to have processed the cases more extensively when the patient appeared poor than in rich-looking patients (p =.04). Discussion Social class seems to influence how extensively doctors think about the patient׳s problem during the diagnostic process but does not influence diagnostic accuracy. Given our findings, it may be worthwhile to replicate the study with a larger number of cases and larger differences in experience between groups of physicians.