— Your emotional state, your weight, and even your intelligence or insurance coverage may affect the way your doctor perceives you, according to a Medscape survey of more than 15,800 doctors.Four in 10 doctors admit they have some degree of bias, or prejudice, toward specific types or groups of patients, according to the survey conducted by WebMD’s site for health care professionals. Doctors from 25 specialties responded to the survey, which is part of Medscape’s annual Physician Lifestyle Report.

Of those that do admit to biases, the two most common triggers were patients’:

  • Emotional problems (62%)
  • Weight (52%)
  • Intelligence (44%)
  • Language differences (32%)
  • Insurance coverage (23%)

When doctors were asked to include other triggers not listed on the survey, many cited drug-seeking by patients, drug abuse, malingering (meaning pretending to be ill or exaggerating it), patient noncompliance, and patients with chronic pain.

Doctors most likely to admit to some degree of bias include:

  • Emergency room doctors (62%)
  • Orthopedists (50%)
  • Psychiatrists (48%)
  • Family doctors and OB/GYNs (47%)

Pathologists, radiologists, and cardiologists were the least likely to say they make preconceived judgments. And the survey found a link between bias and doctor burnout — defined as “loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.” Overall, 55% of doctors who said they are burned out also said they held biases.

”Bias is never a good thing, but when we consider the doctors who hold the most bias also tend to be unhappy on the job and burned out by medical practice, we have a better understanding of the problem,” says Michael W. Smith, MD, WebMD’s chief medical editor.

One survey limitation is that of “implicit” or unconscious bias, which may affect treatment even if doctor is not aware of it. But, as one doctor responding to the survey said, “while my subconscious attitudes and perceptions may be affected, I check these at the door and do my best to be empathetic no matter what.”

A small percentage of doctors who admitted bias in the survey said it actually affects their care of patients — 14% of emergency room doctors, for example, and 12% of plastic surgeons. And the effect of bias on treatment can be positive, negative, or both. One-quarter of those whose perceptions of their patients affect treatment said they tend to overcompensate and give patients special care, while 29% said the treatment effects were negative.