To investigate whether medical housestaff report race information differently during case presentations of black patients
and white patients, a prospective observational study was performed. Without informing housestaff, a chief resident recorded
data during consecutive case presentations over two months. For each presentation, the data included: 1) whether, where, and
how often race was identified; 2) whether certain prospectively selected, “possibly unflattering characteristics” were mentioned;
and 3) whether any “justifying” diagnoses were considered during presentation or subsequent discussion. Justifying diagnoses
were those in which a patient’s race was important in considering the likelibood of possible diagnoses. Twenty-three bouse
officers presented 18 black and 35 white patients. A single East Indian patient was excluded from analysis. Race was specified
more often during presentations of black than of white patients (16 of 18 for blacks vs. 19 of 36 for whites; p<0.01). For
two black patients, a justifying diagnosis was considered, but excluding these patients did not change the results. Two other
differences did not achieve statistical significance. Race was more often specified prominently and repeatedly during presentations
of black patients. Among patients to whom “possibly unflattering” characteristics were attributed, race was more likely to
be specified for blacks (10 of 10) than for whites (4 of 9). These case presentations appeared to show a subtle bias.
Key words case presentation - blacks - race prejudice
Received from the Department of Medicine, The Johns Hopkins University School of Medicine and the Francis Scott Key Medical
Center, Baltimore, Maryland.