Burdex, Ashley
Nejtek, Vicki
Talari, Deepika
Koehl, Steven


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Purpose (a): About 50% of Tarrant County homeless (n=2,123) have co-occurring medical disorders, receive inconsistent medical care, are at high risk for repeated crisis care hospitalization, and are often discharged prior to full stabilization.1,2 Whether or not medical crisis recidivism is influenced by clinical attitudes towards treating the homeless is uncertain. Here, we examined medical student, resident, and physician attitudes about the homeless condition and treating homeless patients. We hypothesize that medical students MS 1-4, residents, and physicians significantly differ in their attitudes in treating homeless patients. Methods (b): A prospective, cross-sectional between-group comparison of the attitudes towards treating homeless patients among medical school students, residents, and physicians (n=238) was conducted. Data were analyzed using analysis of variance (ANOVA) and Chi-square procedures. Statistical significance was determined using a 95% confidence interval and a probability alpha of 0.05. Results (c): The MS 1-2, residents, and physicians showed more empathy and had a higher interest in treating homeless patients than MS 3-4 (p=0.004). In contrast to other groups, MS 3-4 regard homeless people as lazy (p=0.001) and rude (p=0.028). Compared to medical students, physicians and residents believe that health dollars should be directed toward serving the poor and homeless (p=0.001). In comparison to physicians, MS 3-4 do not perceive homelessness as a health issue (p=0.002), and all medical students judged that government should not waste money on homelessness (p=0.001). Further, compared to other groups (especially physicians), MS 3-4 reported that alcoholism is a personal weakness (p=0.003) rather than a medical illness and think that clinicians should only address physical and not social problems (p=0.014). Conclusions (d): Overall, MS 3-4 are significantly more cynical and judgmental about the homeless condition and treating homeless patients than any other group. The lack of biological insight about the medical needs of the poor and homeless expressed by MS 3-4 is truly concerning. These data indicate a critical need for specialized education that will better inform medical students about socioeconomic conditions that significantly influence medical disease onset, etiology and prognostic outcomes in this vulnerable, complex, and difficult-to-treat patient population.