Talking Down to the Patient: How Class Differences Influence Warmth and Competence in Doctor-Patient Interactions

Abstract

Previous literature on cross-status interactions demonstrates not only how class-based stereotypes dictate other’s perceptions of people, but also how those people present themselves to others during social interactions. The present study evaluates perceptions of warmth, competence, and responsibility within a hypothetical doctor-patient interaction – specifically, whether a patient’s social class influences how their physician perceives them, and whether the physician alters their diagnostic approach based on these perceptions. The study also manipulated the complexity of the treatment regimen to evaluate potential interaction effects between patient class and the level of information communicated to the patient. Healthcare industry participants (n = 467) assumed the role of a physician interacting with a hypothetical upper- or lower-class patient and relayed information specific to a diabetes diagnosis and treatment regimen. A significant effect for competence emerged; participants rated lower-class patients as less competent and conveyed less competence in their communication with the patient, particularly when asked to share complex information. Participants’ perceptions of the patient did not differ on dimensions of warmth or responsibility, nor did their self-presentation. This suggests that well-intentioned physicians may not only view their patients in a biased manner based on income or background, but they might also convey a subtle but judgmental attitude toward patients of different circumstances, resulting in a reduced quality of healthcare for many.