Might how you look influence how well you are looked after? A study which demonstrates that GPs perceive socio-economic gradients in attractiveness

Objective: To test the hypothesis that more disadvantaged patients are perceived by general practitioners (GPs) as being less attractive than their more affluent peers. Design: Three hundred and twenty five consecutive ambulant patients attending 15 GPs' surgeries in Northern Ireland, UK, had three digital photographs taken; two of their face (smiling and non-smiling) and one of their face and upper trunk. Photographs were assessed by 30 GPs from practices other than those used to select the patients. Patients were subdivided into 'more affluent', 'average' and 'more deprived' groups based on their household tenure, level of educational attainment and car availability. The age and sex of the GP-assessors was recorded along with the average deprivation score for their own practice population. The relationship between patient, GP and practice characteristics was explored using multilevel modelling to take account of the hierarchical nature of the dataset. The main outcome measure was the perceived attractiveness score of the patient as rated by the GP. Results: Of those invited, 301(92%) participated in the study. The mean age of patients was 49.6 (standard deviation 6.1) years and 59% were female. GPs rated younger patients more attractive than older patients; each additional 10 years reduced the attractiveness scores by an average of 2.7 points (95% confidence intervals 1.4-3.9, P < 0.001). Patients from higher socio-economic backgrounds were assessed as more attractive than their less affluent peers, the mean difference being 7.8 points (5.8-9.9, P < 0.001). The difference in attractiveness scores between affluent and deprived patients was greatest when the GP assessor came from a practice serving predominantly deprived patients. Conclusion: The perceived difference in the average attractiveness scores between affluent and deprived patients is large and, though this study does not prove it, there is sufficient circumstantial evidence to indicate that it might play a significant role in modifying the medical encounter.