Treating the Homeless Patient: Different Attitudes Among Pre-Clinical Medical Students




Patel, Tarang Mukeshbhai
Talari, Deepika
Nejtek, Vicki
Kaushal, Deepika


Journal Title

Journal ISSN

Volume Title



Background: Locally, ~2,123 people are homeless. Most of these have multiple physical and mental illnesses requiring consistent medical treatment that is delivered intermittently. Inadequate medical treatment for the indigent and homeless could potentially be a function of biased healthcare professional attitudes toward the homeless patient. Our previous research examined treatment attitudes of medical students (MS1-4), residents, and physicians and showed that MS3-4 students were cynical and judgmental about the homeless condition and they resented treating the homeless patients more than any other group. Here, we examined if there were any changes in attitudes towards treating the homeless in 2nd year medical students assessed in 2013 in comparison to a different group of 2nd year medical students assessed in 2014. Hypothesis: Attitudes about treating the homeless will significantly differ between two groups of of 2nd year medical students. Methods: A cross-sectional between-group comparison of attitudes toward treating homeless patients was conducted in 2nd year medical students MS2_1 (n=66) and MS2_2 (n=72). All ages and race/ethnic groups were eligible to participate. The Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI) and the Attitudes Toward the Homeless Questionnaire (ATHQ) were used to quantify attitudes. Socio-demographic data were analyzed using frequency distributions and chi-square analyses. Group differences in HPATHI and ATHQ scores were analyzed using general linear modeling to correct for unequal group sizes. Statistical significance was determined using a 95% CI and a p-value of 0.05. Results: We found the MS2_1 group was significantly more judgmental in that they reported that ‘homelessness was self-inflicted’ (p=0.013), and that they believed that ‘alcoholism is a personal weakness’ (p=0.001). The MS2_1 thought that ‘homelessness was not related to health issues’ (p=0.038). The MS2_2 rated themselves significantly higher than the MS2-1 group as ‘going into medicine to help the needy’ and that ‘social injustice is an important healthcare issue.’ Gender and race were not influencing factors on these results. Conclusion: These results suggest that 2nd year medical students assessed in 2013 had a substantial bias towards treating homeless patients and had very poor insight on the biological basis for addiction. These data warrant a larger investigation to determine if this was just a cohort effect that has since been resolved, or if the educational requirement and coursework that the 2013 group of medical students experienced was different than that received by the 2014 students. Nevertheless, curriculum that adequately prepares students to practice real-world community medicine in special needs populations like the homeless is important, as is the need for more in-depth curriculum to teach the biological basis for addiction.