UC Berkeley

In the healthcare context, patient socioeconomic status (SES) informs how patients are perceived and treated, contributing to downstream health disparities. In Chapter 1, experimental research reveals the nature of such interpersonal challenges for low-SES patients. Across four experiments (total N = 1142), participants engaged in a series of mock telehealth visits with a patient who failed to follow treatment recommendations twice and was therefore noncompliant. Analyses revealed that after repeated noncompliance, a low-SES patient was perceived disproportionately more harshly, as more lazy, less honest, and as exaggerating their pain more, than a high-SES patient exhibiting the same noncompliant behavior. These worsening perceptions of the patient predicted lower intentions to invest in care for the patient in the future. Furthermore, low-SES patients received less intense treatment than high-SES patients regardless of patterns of noncompliance. These findings for low-SES bias in the healthcare context are not moderated by patient race or gender. Internal meta-analyses provide additional support for these findings. In Chapter 2, a mindset intervention called “Empathic-care” was tested to mitigate the consequences of social class bias on patient outcomes. Across three experiments (N = 925), healthcare professionals participated in a randomized controlled trial (RCT) wherein the Empathic-care condition used engaging and reflective exercises to promote empathy when interacting with patients, even under challenging interpersonal circumstances. In response to the mock telehealth vignette from Chapter 1, Empathic-care improved healthcare providers' attitudes about patient-provider relationships and reduced negative perceptions of a noncompliant low-SES patient. Analyses revealed that the Empathic-care components emphasizing trust-building and perspective-taking were most impactful, promoting more positive views of patients' honesty, reducing perceptions that patients were exaggerating pain, decreasing frustration, and fostering growth mindsets about patients' capacity for change. These findings suggest that biased treatment of patients due to their SES plays a pivotal role in social class health disparities, but that a brief but impactful psychological intervention can mitigate the consequences of social class bias.