We created a web-based survey instrument that randomly assigned participants to see a picture of a black or white patient while reading a clinical vignette. From hundreds of shareware photographs, we chose 58 whose facial expressions appeared neutral. We created new patient images by morphing together these photographs using Photo Morpher Software (Morpheus Software, LLC, Santa Barbara, Calif, USA). The 21 best quality images were chosen and 19 independent evaluators (physicians, research assistants, and graduate students of various racial/ethnic backgrounds and not involved in the study) reviewed these. We chose four (two black and two white) that were most closely matched on apparent age (approximately 50 years) and attractiveness (7-point scale). The vignette (see Appendix) describes a 50-year-old male presenting to the emergency department with chest pain and an electrocardiogram suggestive of anterior myocardial infarction. It is stated that primary angioplasty is not an option and no absolute contraindications to thrombolysis are evident.
