You may be wrong on which patients will sue
Research indicates that income not as important as respect
Although some physicians won't treat Medicaid or uninsured patients because of a perception that low-income patients are more likely to sue, new research shows the opposite is true.1 Researchers reviewed studies on differences in litigation rates and found that socioeconomically disadvantaged patients were less likely to sue.
The results came as no surprise to orthopedic surgeons who treat patients who happen to be socioeconomically marginalized, according to Ramon L. Jimenez, MD, a senior orthopedic consultant at the Monterey (CA) Peninsula Orthopaedic and Sports Medicine Institute and past chair of the American Academy of Orthopaedic Surgeons' Diversity Advisory Board.
"We knew there was a prevalent myth that poor patients sue more," says Jimenez. "This is promoted by surgeons with an unconscious bias toward treating poor patients who may not be able to pay for services."
There is no solid evidence that a certain type of patient is more likely to sue, according to Jimenez, but patients who are dissatisfied with the services of their physician are more likely to do so. "It has been shown that physicians who practice good physician-patient communication skills experience less likelihood of being sued," he says.2,3
Physicians who don't treat Medicaid patients typically cite low reimbursement as the reason, says Frank M. McClellan, co-director of Temple University's Center for Health Law Policy and Practice in Philadelphia. "It was surprising to find evidence that when asked directly about concern for being sued, many physicians believed that poor people were more likely to sue them than people who were financially better off," says McClellan.
It also was surprising to discover studies revealing that a significant number of people on Medicaid who filed medical malpractice suits became eligible for Medicaid recently, he adds. "This was due to a radical change in their financial condition due to the medical accident that gave rise to the lawsuit against a healthcare provider," says McClellan.
Respect deters suits
Disrespect, poor communication, and a desire to get the truth about what caused an injury or death are major contributing factors motivating individuals to sue doctors and hospitals, according to McClellan.
While some physicians envision lawyers as eager to file a medical malpractice suit to obtain a large fee, contingency cases mean an attorney only gets paid if the case is won in court or settles, he notes.
Slip and fall cases and automobile accidents are usually not expensive to litigate, but medical malpractice cases are costly, risky, and hard fought because of the stakes to providers and patients, adds McClellan. Consequently, lawyers are reluctant to invest time and reSources in medical malpractices cases on a contingent fee basis, without evidence based on credible expert testimony that there is a reasonable basis of winning the case if it goes to trial, says McClellan.
"Studies show that providers and insurers rarely pay substantial sums to settle frivolous medical malpractice cases," he adds.
If a physician harbors misconceptions about low-income or Medicaid patients being more likely to sue them, these misconceptions might result in disrespectful treatment and feelings of distrust, says McClellan.
"Improve relationships through training to increase cultural competency and communication skills," he advises. "The best deterrent to a lawsuit is to practice good medicine and respect patients." (For more information on training programs, see resource box, below.)
References
- McClellan FM, White III AA, Jimenez RL, et al. Do poor people sue doctors more frequently? Confronting unconscious bias and the role of cultural competency. Clin Orthop Relat Res 2012; 470(5):1,393-1,397.
- Levinson, W. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997; 277(7):553-559.
- Hickson GB, Jenkins AD. Identifying and addressing communication failures as a means of reducing unnecessary malpractice claims. NC Med J 2007; 68:362-364.
Resources/Sources
For more information on low-income patients and liability risks:
- Ramon L. Jimenez, MD, Monterey (CA) Peninsula Orthopaedic and Sports Medicine Institute. Phone: (831) 643-9788. Fax: (831) 657-0161. Email: [email protected].
- Frank M. McClellan, Co-Director, Center for Health Law Policy and Practice, Temple University, Philadelphia. Phone: (215) 204-1609. Fax: (215) 204-1185. Email: [email protected].
- Coaching physicians on communications skills with one-on-one observation is available from the Center for Healthcare Communication. The cost for the three-phase process (extensive assessment, one full day of observation, and follow-up) is $2,500, with discounts for multi-physician projects. For more information, contact the center at: P.O. Box 18819, Cleveland, OH 44118. Phone: (800) 677-3256 or (440) 338-3056. Fax: (440) 338-3076. Email: [email protected]. Web: www.CommunicatingWithPatients.com.
- The American Academy of Orthopaedic Surgeons offers a four-hour interactive workshop, the Communication Skills Mentoring Program, in which physician-patient communication skills are learned and practiced. For more information, send an email to [email protected]. To contact a mentor in your area, go to www.aaos.org. Select "Physician Education," "Communication Skills," and "Mentor Location Map."
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