[The physician and his poor patient--time for change]

Poverty and inequality will become increasingly part of the physician's realm of work. They have an impact on mortality, morbidity and on quality of life. Research has shown that physicians relate differently to poor patients, especially in relation to prescribing, but also in relation to referrals and during the consultation. They themselves are often unaware of this inclination. Physicians tend to relate to the poor in general terms, rather than to specific poor patients. Some physicians prefer not to treat poor patients at all. Physicians who come from a disadvantaged background and physicians who have had contact with the needy are predisposed to treat poor patients more often. Medical students who came in contact with poor populations, during or even before their studies, tended to relate more positively to poor persons after graduation. Medical schools that instituted special programs to educate towards lessening inequality succeeded in changing graduates' perceptions and behavior related to the poor. Solutions to lessen inequality in health include: a strong primary care sector, patient empowerment, corrective economic measures and the use of quality control and performance indicators as a means of reducing inequality. There is a need to increase awareness of the relevant components of the interaction between the physician with his poor patient and enhance the development of appropriate educational programs in medical schools.