‘Suburban patients are a Different Class’

Dr Burnt Out’s light-hearted musings on the difference that class makes in patient consultations

One of the things about living in the UK is that you cannot get away from the issue of social class. It is so deeply ingrained into the fabric, history and culture of the country. Author George Orwell considered himself a member of the ‘lower-upper-middle class’ – such are complexities of this area. He also commented: ‘England is the most class-ridden country under the sun. It is a land of snobbery and privilege, ruled largely by the old and silly.’

Yes, the UK really is, and always has been, the most class-ridden country on the planet. And any practising GP will be able to confirm that too, I reckon.

I am lucky enough to have worked in quite a few GP practices in different parts of the country. I have seen many different patients from right across the social spectrum, and so feel equipped to share some of my general observations from over the years.

The aristocracy and upper classes are generally very easy patients to see. They don’t like ‘bothering the doctor’ with trivia, and are more than likely to enter your consultation room holding a severed finger they have cut off accidentally on the farm or in the kitchen wondering out loud if they should go to hospital. 

Yes, absolutely, some of them are a bit dim as well, but that’s what goes with the shallow gene pools of the British aristocracy.

Quite a lot of them don’t actually have as much money as you may think, as they have often been bankrupted by huge family estates and the upkeep of large crumbling country houses, so more often then not they will go with ‘the good old NHS’, rather then go private. And it would not go amiss to say that a fair few of them are laissez-faire with their health and wouldn’t countenance reducing their gin intake on account of their slightly raised liver enzymes. 

The middle class are a complex bunch and I say this with an appreciation that most of you readers will probably fit into this category somewhere. There is no misery on earth like self- inflicted middle class misery; they pepper their social conversations regularly with the words ‘mortgage’ and ‘school fees’. In my experience, this group includes some of the most awful and excruciating patients in the universe (mainly in the upper-middle variety) who will speak to you for endless hours about why their vitamin D levels may have dropped slightly or the significance of a haematocrit that is 0.02 units above the reference range. Yes, like I said, excruciating.

You sometimes feel like committing Harakiri with a biro after spending more than 20 minutes discussing a single blood test result, or medication side effect. 

Therefore, the middle class can be quite a challenging group to consult with: high expectations, often quite demanding, high levels of neurosis and health anxiety – and financially squeezed for the lifestyle they try to aspire to (which has psychological consequences for them).

Of course – some of them are lovely. 

I am unsure whether using the term ‘working class‘ is outdated in 2025. It may be best to put ‘people at a socioeconomic disadvantage’ instead; although many people would still describe themselves as ‘proudly working class’. 

Again quite a complex mixture but often surprisingly easy to consult with. I once saw a guy who nonchalantly walked into my room, casually told me he was ‘shot a couple of times’ a few weeks previously and started casually peeling off a dressing for me to inspect his wound.

He didn’t even want a sick note and he was happy with me just taking a look, saying it looked OK and was back out through the door again in a flash. Often this group is the most grateful; you get cards and presents that are expensive for the paltry PIP or DLA payments that they receive. (NB: You never get presents from the middle classes; the upper classes do give presents but it’s usually something that they own already – often for quite a long time that’s been retrieved from a cellar.) 

In some ways, this group is quite similar in treating the upper classes; they are significantly easier to consult with in comparison to the complex middle class picture. 

That’s why the suburbs are such hell to be a GP in ( please excuse me if you work in the suburbs, I’ve done it and feel your pain). The endless and meaningless conversations about minor and completely insignificant blood test anomalies where they are a nano-unit above or below a reference range and everyone in a heightened state of often completely pointless anxiety. As in most areas the ones who genuinely are ill often don’t make much if any fuss, or are completely drowned out by the masses of worried well. 

I’m going to say again that these are of course all broad generalisations – every patient is a unique being and none of us fit squarely into any defined box. But the patterns are hard to ignore, and I suspect most GPs reading this will recognise some familiar truths. Social class shapes how illness is perceived, presented, and received. And this is particularly visible in general practice; it was a GP after all who first proposed the ‘inverse care law‘.

All that is to say: give me a crack addict going berserk in the waiting room any day. At least when he or she calms down you’re more likely to get a box of chocolates. 

There is one final breed that I’m quite familiar with: the middle classes that pretend to be working class. In London this was the so-called ‘mockney’ a la Guy Ritchie and Nigel Kennedy. I grew up in a pretty mixed and rough area in the 1970s and 1980s where my main task in life was to avoid getting beaten up on the way back from school, and I mixed with a wide group of kids from all sorts of backgrounds.  

There were some in this group who like Guy Ritchie came from pretty well off and privileged backgrounds who went ‘gangsta’ sometime during their teenage years and never reverted back, I suppose to fit in and be ‘street’, a bit like other famous mockneys like Lily Allen, Joe Strummer and Damon Albarn. 

I suppose it was the well-off pretending to be poor, or of a different class, that Jarvis Cocker satirised and made fun of in Pulp’s classic 1995 anthem ‘Common People‘:

I said, ‘Pretend you got no money”
And she just laughed and said, “Oh, you’re so funny’
I said, ‘Yeah…
Well, I can’t see anyone else smiling in here‘

Dr Burnt Out is a GP locum in London