The Season for Giving and Accepting Gifts from Patients

Consider the following scenarios:*

• Mr A has been an inpatient for an extended period of time. Upon his discharge just prior to Christmas, he presents his doctor with a large box of chocolates and a card thanking the wonderful staff for all of their attention during his admission.

• Ms B has had an extended stay on the surgical ward and has come to know the surgical registrar quite well. On discharge, she presents the registrar with a very expensive bottle of French champagne, as well as a pair of champagne flutes.

• Newly widowed Mrs C tearfully presents $4,000 as a token of her gratitude to the consultant who had cared for her husband during his illness with prostate cancer.

However, gifts to doctors from drug companies are currently under much scrutiny, and the RACGP recently recommended that any gift or payment worth $10 or more should be disclosed if a practitioner receives more than $100 a year from an individual drug company.¹ Should patient gifts be subject to the same scrutiny?

Most gifts from patients are a natural and innocent seasonal gesture of goodwill from an appreciative patient, motivated by gratitude or cultural customs. The majority of patients have no expectation of preferential treatment or other benefit in response to their gift. However, a small number of patients may have another agenda. It may be their assumption or intention that their gift entitles them to additional services such as appointments on demand, favourable insurance reports or flexibility in practice rules. If you accept such a gift, you may find it difficult to refuse such requests.

Accepting gifts can also be a serious transgression of professional boundaries, and may have special significance for the patient. Token and small gifts of appreciation are probably not of great concern unless offered frequently, but acceptance of substantial gifts or personal items may be regarded as unethical by your colleagues and the Medical Board.

According to the Medical Board’s Good Medical Practice: A Code of Conduct for Doctors in Australia:

Doctors must be honest and transparent in financial arrangements with patients. Good medical practice involves… not encouraging patients to give, lend or bequeath money or gifts that will benefit you directly or indirectly.²

Proceed with caution

Although classic psychoanalytical teaching states gifts from patients should never be accepted because they conceal unconscious motives,³ rejection of a gift may be interpreted as a lack of regard for the patient’s wishes and may hurt their feelings, irrevocably fracturing the doctor-patient relationship.⁴

In practice, doctors should use their discretion regarding whether or not to accept the gift, taking into account the motivation of the giver, the timing, the nature of the gift and its monetary value. If you feel uncomfortable about accepting the gift for any reason, you should decline.

If you are declining the gift, do it with sensitivity in order to avoid offending or embarrassing the patient. It may be helpful to explain the rejection in terms of a general policy and/or ethical obligation that may help the patient understand the rejection is not personal. For example: “I appreciate your gesture, but hospital policy does not permit us to accept gifts of this value.”⁵

Postscript

The chocolates from Mr A were enjoyed by all at the ward Christmas party.

Ms B’s surgical registrar felt uncomfortable about the gift of champagne and glasses. He sought advice from his medical defence organisation and tactfully declined the gift, explaining that he was ethically unable to accept such a gift. He also ensured that her follow-up outpatient appointment was with another doctor.

The consultant explained to Mrs C that he could not accept a gift of $4,000. Mrs C was very upset but, after further discussion, decided to donate the money to prostate cancer research.

Dr Jane Deacon
Medico-legal Adviser
MDA National

*Please note these scenarios are fictitious.

This is an adapted version of the original article by Dr Jane Deacon which first appeared in the RACGP Good Practice magazine December 2013.

If you’re unsure about how to deal with a gift from a patient, please contact our Medico-legal Advisory Service for advice on 1800 011 255 or email: advice@mdanational.com.au

 

MDA National is supporting the AMA Queensland Foundation’s Thank You Doctor Campaign which offers doctors the opportunity to receive “gifts” from patients without transgressing ethical and professional boundaries, while supporting a worthwhile cause. For more information, visit: amaqfoundation.com.au.

1. RACGP submission to Medicines Australia: Medicines Australian Code of Conduct Review – Transparency Model Consultation and Discussion Paper. Available at: racgp.org.au/yourracgp/news/reports/201309macocr. Accessed October 2013.

2. Good Medical Practice: A Code of Conduct for Doctors in Australia. Available at: medicalboard.gov.au/Codes-Guidelines-Policies. Accessed October 2013.

3. Spence S. Patients Bearing Gifts: Are There Strings Attached? BMJ 2005;331: 1527-29.

4. Lyckholm LJ. Should Physicians Accept Gifts from Patients? JAMA 1998;280: 1944-46.

5. NSW Health Directive: Conflicts of Interest and Gifts and Benefits. Available at: health.nsw.gov.au/policies/pd/2010/PD2010_010.html. Accessed October 2013.