Bogan Bias: Addressing Class-Based Prejudice in Physician-Patient Interactions

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.