Clinical Orthopaedics and Related Research®

, Volume 470, Issue 5, pp 1393–1397

Do Poor People Sue Doctors More Frequently? Confronting Unconscious Bias and the Role of Cultural Competency

  • Frank M. McClellan
  • Augustus A. WhiteIII
  • Ramon L. Jimenez
  • Sherin Fahmy
Evolving Medicolegal Concepts

DOI: 10.1007/s11999-012-2254-2

Cite this article as:
McClellan, F.M., White, A.A., Jimenez, R.L. et al. Clin Orthop Relat Res (2012) 470: 1393. doi:10.1007/s11999-012-2254-2



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.


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.


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.


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.


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.

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Frank M. McClellan
    • 1
  • Augustus A. WhiteIII
    • 2
  • Ramon L. Jimenez
    • 3
  • Sherin Fahmy
    • 4
  1. 1.Temple University Center for Health Law, Policy and Practice, James E. Beasley School of LawTemple UniversityPhiladelphiaUSA
  2. 2.Culturally Competent Care Education Program and Department of Orthopaedic Surgery, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  3. 3.Monterey Orthopaedic and Sports Medicine InstituteMontereyUSA
  4. 4.James E. Beasley School of LawTemple UniversityWilmingtonUSA

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