Abstract
There is a widespread belief in the ‘classlessness’ of Australian society, despite strong evidence demonstrating the impacts of socioeconomic status (SES) on individuals’ educational attainment, health, and mortality. Disparities in health care are also prevalent. The quality of communication between physicians and patients is associated with health outcomes and patient satisfaction, and we argue that this communication can be influenced by socioeconomic bias and prejudice. The majority of medical students in Australia are from backgrounds of high SES, and this is likely to influence their communication as physicians with patients from lower SES communities. In particular, mediatised representations of the Australian working-class as ‘the bogan,’ and the acceptability of derogatory humour towards those perceived to be ‘bogans’ – in the absence of lived experience and understanding of lower SES life – can influence the attitudes, expectations, and behaviour of physicians working in low SES communities. To begin to address these biases, we recommend expanding cultural competence training to reflect a multidimensional understanding of culture that includes SES, and going beyond cultural competence to promote self-reflexivity and critical awareness of personal socio-cultural backgrounds, assumptions, and biases, in staff induction programs.
Highlights
A widespread belief in the egalitarian, ‘classless’ nature of our society is held across Australia
We examine key representations of the workingclass in contemporary Australia and explore how these may influence the biases, communication, and behaviour of medical professionals working in low-socio-economic status (SES) areas
Contemporary attitudes to the Australian working-class The strong belief in a ‘classless’ Australia continues despite growing inequality (Leigh, 2013; Nichols, 2011), with recent data estimating that 14.4 percent of Australians live in relative poverty compared with an OECD average of 11.3 percent (OECD, 2014)
Summary
A widespread belief in the egalitarian, ‘classless’ nature of our society is held across Australia. The levels of trust, participation and satisfaction held by patients affect compliance and commitment to treatment (Major et al, 2013), and it is important for health care providers to be aware of the two-way communication and to work towards building a relationship based on mutual trust and respect The absence of this nuanced understanding of cross-status communication, and the presence of class-based biases, can lead to differential quality of care and disparities in health outcomes (Phelan et al, 2013). Inadequate cultural competency training and the impact of (unconscious) bias while students are at medical school or come into contact with people from lower-SES groups – including “informal influences” in medical schools, such as peer-to-peer interaction and “derogatory humor” – can lead to the development of misconceptions and reinforcement of negative stereotypes Reductions in explicit bias can occur through education and increased self-awareness, and implicit orientations can be reduced by personal contact with individuals from the group for which the bias holds, if this contact is undertaken alongside adequate education and preparatory work (Rudman, 2004)
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