Abstract After assessing the evidence on social class differences in the rates and nature of general practice consultations, the Black Report proposed that middle-class patients receive a better service from GPs than do their working-class contemporaries. This paper reviews the literature on which this suggestion is based and presents further evidence from a study of communication in general practice, as to the extent and nature of social class differences in consultations.
The results of the study suggest that middle-class patients are more active than working-class patients in presenting their ideas to the doctor and in seeking further explanation of his views from him or her. However, this greater activity does not necessarily mean that middle-class patients get more benefit from the consultation, at least in terms of its cognitive outcomes: similar proportions of working-class and middle-class patients received explanations from the doctor and similar proportions misunderstood and rejected his views and advice. These findings point to the important distinction between ‘process’ and ‘outcome’ and underline the need for further research which assesses social class differences in the outcomes as well as the processes of consultations.