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Patient attractiveness reduces the likelihood of a missed diagnosis: implications for person-centered healthcare

Evangelia Tsiga, Efharis Panagopoulou, Alexios Benos


Objective: No study has so far examined the biases associated with the physical attractiveness stereotype during the process of medical decision making. This study assessed the impact of patients' attractiveness on the diagnosis of kidney or bladder stones.

Methods: A computer-based, within-subjects experimental design was used. 34 male family physicians were presented with the same clinical scenario of a 25-year old woman presenting with dysuria complaints. Participants were then presented with facial photos of attractive and unattractive female patients interchangeably. Each photo was followed by a KUB X-ray of kidney or bladder stones. Participants were asked to describe the X-rays.

Results: Controlling for the effect of clinical experience, doctors were 3.67 times more likely to miss the diagnosis of kidney or bladder stones on the X-rays of unattractive patients compared to the X-rays of attractive patients (B=1.299, p = .020, Exp(B)=3.667).

Conclusion: This study highlights the cognitive biases associated with patient attractiveness during the diagnostic process. It shows that patient attractiveness interferes with physicians' information processing when reading an X-ray, and decreases the likelihood of a missed diagnosis.

Practice Implications: The results of this study have severe implications in patient safety and the improvement of the delivered quality of care.


medical decisions; medical errors; physical attractiveness; stereotypes

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Langlois, J.H., Kalakanis, L., Rubenstein, A.J., Larson, A., Hallam, M. & Smoot, M. (2000). Maxims or myths of beauty? A meta-analytic and theoretical review. Psychological Bulletin 126 (3) 390-423.

Shepherd, J.W. & Ellis, H.D. (1973). The Effect of Attractiveness on Recognition Memory for Faces. American Journal of Psychology 86 (3) 627-633.

Nordholm, L.A. (1980). Beautiful patients are good patients: evidence for the physical attractiveness stereotype in first impressions of patients. Social Science and Medicine 14A (1) 81-83.

Bordieri, J.E., Sotolongo, M. & Wilson, M. (1983). Physical attractiveness and attributions for disability. Rehabilitation Psychology 28 (4) 207-215.

Hansson, R.O. & Duffield, B.J. (1976). Physical attractiveness and the attribution of epilepsy. Journal of Social Psychology 99 (2) 233-240.

Cash, T.F., Kehr, J.A., Polyson, J. & Freeman, V. (1977). Role of physical attractiveness in peer attribution of psychological disturbance. Journal of Consulting and Clinical Psychology 45 (6) 987-993.

Jones, W.H., Hansson, R.O. & Phillips, A.L. (1978). Physical attractiveness and judgments of psychopathology. Journal of Social Psychology 105 (First Half) 79-84.

Schwartz, J.M. & Abramowitz, S.I. (1978). Effects of female client physical attractiveness on clinical judgment. Psychology and Psychotherapy: Theory, Research and Practice 15 (3) 251-257.

Hadjistavropoulos, H.D., Ross, M.A. & von Baeyer, C.L. (1990). Are physicians’ ratings of pain affected by patients’ physical attractiveness? Social Science and Medicine 31 (1) 69-72.

Hardy, D. & Smith, B. (2008). Decision Making in Clinical Practice. British Journal of Anaesthetic and Recovery Nursing 9 (1) 19-21.

Hobfoll, S.E. & Penner, L.A. (1978). Effect of physical attractiveness on therapists’ initial judgments of a person’s self-concept. Journal of Consulting and Clinical Psychology 46 (1) 200-201.

Aharon, I., Etcoff, N., Ariely, D., Chabris, C.F., O’Connor, E. & Breiter, H.C. (2001). Beautiful faces have variable reward value: fMRI and behavioral evidence. Neuron 32 (3) 537-551.

Olson, I.R. & Marshuetz, C. (2005). Facial attractiveness is appraised in a glance. Emotion 5 (4) 498-502.

Sui, J. & Liu, C.H. (2009). Can Beauty Be Ignored? Effects of Facial Attractiveness on Covert Attention. Psychonomic Bulletin and Review 16 (2) 276-281.

Gunderman, R.B. (2009). Biases in Radiologic Reasoning. American Journal of Roentgenology 192 (3) 561-564.

Sonderegger-Iseli, K., Burger, S., Muntwyler, J. & Salomon, F. (2000). Diagnostic errors in three medical eras: a necropsy study. Lancet 355 (9220) 2027-2031.

Gandhi, T.K., Kachalia, A., Thomas, E.J., Puopolo, A.L., Yoon, C., Brennan, T.A. & Studdert, D.M. (2006). Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Annals of Internal Medicine 145 (7) 488-496.

Graber, M.L., Franklin, N. & Gordon, R. (2005) Diagnostic error in internal medicine. Archives of Internal Medicine 165 (13) 1493-1499.



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