PURPOSE: Although previous studies have examined race and sex differences in health care, few studies have investigated the possible role of physician bias. We evaluated the influence of race and sex on medical students’ perceptions of patients’ symptoms to determine if there are differences in these perceptions early in medical training.

SUBJECTS AND METHODS: One-hundred sixty-four medical students were randomly assigned to view a video of a black female or white male actor portraying patients with identical symptoms of angina. We evaluated students’ perceptions of the actors’ health state (based on their assessment of quality of life) using a visual analog scale and a standard rating technique, as well as the type of chest pain diagnosis.

RESULTS: Students assigned a lower value (indicating a less desirable health state) to the black woman than to the white man with identical symptoms [visual scale (mean ± SD): 72 ± 13 vs 67 ± 12, P <0.02; standard gamble: 87 ± 10 vs 80 ± 15, P < 0.001). Nonminority students reported higher mean values for the white male patient (standard gamble: 89 ± 8 vs 81 ± 14 for the black female patient), whereas minority students’ assessments did not differ by patient. Male students assigned a slightly lower value to the black female patient (standard gamble: 76 ± 16 vs 87 ± 10 for the white male patient). Students were less likely to characterize the black female patient’s symptoms as angina (46% vs 74% for the white male patient, P = 0.001).

CONCLUSIONS: The way that medical students perceive patient symptoms appears to be affected by nonmedical factors.