Appendix 33 - Poor Judgement

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

In 1968, Tufts medical students had an opportunity to spend two months making house calls in the inner city. It was described as the first time that most of the students had been directly confronted with the, "full realities of lower-class life and the culture of poverty."

Interested in the students' psychological reaction to working with the poor, researchers conducted a number of surveys. They expected the students to talk a great deal about how depressing it is to see people living in such circumstances. Instead, the students evidently "accepted at face value the stereotype of the poor as happy-go-lucky, self-indulgent manipulators...." Tufts has changed over the last thirty years - students no longer do house calls - but the attitudes haven't.

About a third of the students in the 1968 study expressed the belief that the poor, "were not really so bad off; that they had brought about their own misfortunes through stupidity and perverse unwillingness to be provident; and they shamelessly refused to admit their mistakes."[379] The "Just World Hypothesis," proposed by M.J. Lernar in the 60's, has been used to explain doctor's views of indigent patients. The theory holds that innocent victims of misfortune threaten the belief that people "deserve what they get and get what they deserve." In such cases of misfortune, the observer attempts to restore justice by, "derogating the victim to convince himself that this victim is the kind of person who deserves to suffer."[380]

The poor, "are considered the least desirable patients."[381]

In a study of psychiatrists and psychologists, bias against lower class patients was found to be operating in all professional groups at all stages of training.[382] Patients of higher social classes (and white patients) were found to receive, "more information, more positive talk, and more talk overall" from physicians than patients of lower classes and minorities.[383]

From a JAMA article Patch recommended, "Medicine had largely abandoned the poor.... We know that it does little good to offer a medication when our patient needs a home, a meal, a family, love, money and a thousand other things that we ourselves take for granted."[384] George Bernard Shaw: "When you are so poor that you cannot afford to refuse eighteenth pence from a man who is too poor to pay you any more it is useless to tell him that what he or his sick child needs is not medicine, but more leisure, better clothes, better food, and a better drained and ventilated house."

The JAMA article continues, "We don't know what to do [for the homeless, the very poor] and so we turn away, offering nothing. Compassion is exiled."[385]


[379] McMahon, AW and MF Shore. Archives of General Psychiatry 18(1968):562-568.

[380] Fasano, LA, PR Muskin, and RP Sloan. Academic Medicine 68(1993):S43-S45.

[381] Medical Sociology:165.

[382] Umbenhauer, SL and LL DeWitte. Comparative Psychiatry 19:509-515.

[383] Price, JH, et al. Journal of Family Practice 27(1988):615-621.

[384] Hilfiker, D. "Unconscious on a Corner..." JAMA 258(1987):3155-3156.

[385] Ibid.

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