title: Do poor people sue doctors more frequently? Confronting unconscious bias and the role of cultural competency.
abstract: BACKGROUND
  There is a perception that socioeconomically disadvantaged patients tend to sue their doctors more frequently. As a result, some physicians may be reluctant to treat poor patients or treat such patients differently from other patient groups in terms of medical care provided.
  
  
  OBJECTIVE
  We (1) examined existing literature to refute the notion that poor patients are inclined to sue doctors more than other patients, (2) explored unconscious bias as an explanation as to why the perception of the poor being more litigious may exist despite evidence to the contrary, and (3) assessed the role of culturally competent awareness and knowledge in confronting physician bias.
  
  
  METHODS
  We reviewed medical and social literature to identify studies that have examined differences in litigation rates and related medical malpractice claims among socioeconomically disadvantaged patients versus other groups of patients.
  
  
  RESULTS
  Contrary to popular perception, existing studies show poor patients, in fact, tend to sue physicians less often. This may be related to a relative lack of access to legal resources and the nature of the contingency fee system in medical malpractice claims.
  
  
  CONCLUSIONS
  Misperceptions such as the one examined in this article that assume a relationship between patient poverty and medical malpractice litigation may arise from unconscious physician bias and other social variables. Cultural competency can be helpful in mitigating such bias, improving medical care, and addressing the risk of medical malpractice claims.
authors.affiliation: Temple University Center for Health Law, Policy and Practice, James E. Beasley School of Law, Temple University, Philadelphia, PA, USA.
authors.forename: Frank M
authors.initials: FM
authors.lastname: McClellan
authors.forename: Augustus A
authors.initials: AA
authors.lastname: White
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Jimenez
authors.forename: Sherin
authors.initials: S
authors.lastname: Fahmy
mesh_terms: D054521:Cultural Competency / Q000523:psychology*; D006801:Humans; D007883:Legislation, Medical; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000331:legislation & jurisprudence / Q000523:psychology; D008489:Medical Indigency; D008511:Medicine / Q000592:standards; D009042:Motivation; D010361:Patients / Q000331:legislation & jurisprudence / Q000523:psychology*; D010817:Physician-Patient Relations; D011203:Poverty; D011287:Prejudice