“Pick one.. it’s Yours”: Patient Gifts to Their Doctors
When I was an intern at Philadelphia General Hospital, my introduction to the hospital was on the general medical ward. This particular ward was where the firemen and policemen went when they were sick and also the politicians of the city. I remember that one of the first patients I was responsible for was a politician. I came to the bedside to perform the patient’s first history and physical in the hospital. I remember, I was greeted with a smile as I approached and then the patient raised his arm. On his wrist were several expensive looking watches. His words to me: “Pick one.. it’s yours.” Well, I didn’t. I felt he was trying to “buy” my personal attention and service before I even started. (Remember, I said he was a politician!) I politely refused his offer and explained that a watch wasn’t necessary. It was my responsibility to provide care to all hospital patients and I would be satisfied to take care of him without a watch. After a bit of further urging, he finally gave up and I did my task without further event.
This episode in my medical experience has been long remembered (40 some years) but also brings up the ethical issue of whether physicians should ever accept gifts from patients. If so, under what circumstances and what kind of gifts? I think it is improper to accept a gift before the act of attending to the medical needs of the patient as in the my intern experience. But what about a gracious gift representing thanks and appreciation for my services after they have been completed? Certainly, it would be inconsiderate of the feelings of the patient to refuse. Would a gold watch be acceptable or should it be a home-made fruit cake? Where does one draw the line? How about a monetary “tip”? I never had that! But if this was offered to me, should I accept that like my barber does? If so, how much of a tip is acceptable? I realize that his issue of a patient’s gift is not the most important issue in medical practice but it does represent ethical concerns: Avoiding acts which may be seen as or indeed are conflicts of interest in the practice of a just form of medicine for all patients could also be paternalistically ignoring the emotional needs of the treated patient to relate to the physician. Before I go any further, I welcome the views of my visitors including physicians. ..Maurice.
posted by Maurice Bernstein, M.D. @ 7:54:00 PM
16 comments
16 Comments:
I personally have no problem accepting small gifts as a token of appreciation. I would refuse anything of substantial value, unless I had provided service to the patient that was somehow extraordinary (I don't think I've ever faced this dilemma)
It is not unusual for our patients to bring in homemade sweets as a token of appreciation. I think accepting such gifts allows patients to express appreciation w/o the expectation of any special service.
If someone wanted to make a more substantial gift, I'd try to direct them to the hospital as a whole.
It is intersting to consider why gifts from patients are acceptable and those from drug companies, in appreciation, say, of prescribing their drugs, are not.
To Dr. Andy: With regard to your concern about acceptability, you might wish to read my posting for today April 19th. It is a poem about giving gifts. The poem says that one who gives the gift should " Give soulfully, without cunning." I would say that the usual gift from the patient is given that way. The gift from the drug company is given with other motives and certainly NOT without "cunning". ..Maurice.
As a patient, I have sometimes given gifts. Once, it was a plaque I personally embellished with the doctor's child's letter that had appeared in the local paper. Another was an elaborate gingerbread house featuring "stores" with the names of the staff on them. I did these things out of love (doesn't everyone complain that there is not enough love in the world?). I realize that in another time I would not have survived my illnesses, but due to technology and my doctor, I have. There are no words for my gratefulness. Also, once I was hurt to see a thank you in my chart (even though intellectually I knew this occurs). It was like my own loving expression was already being set-up as a defense against myself, should some sort of litigation take place. I find this personally painful, no matter that the world is sue-happy. My gifts now are 3-D, and I leave it to the doctor how he will attach them to my chart.
I can see that Anonymous is a bit concerned about the physician placing her "thank you" note in the her chart. Although it would not be unusual or unprofessional for such a note to be put in the chart, other notes which are not as beneficient may also be put there. The chart is a document to describe the patient, the patient's illnesses and the courses of treatment. The best protection from the consequences of litigation but also to benefit patient care for any physician is to avoid a scanty, non-descriptive chart. If Anonymous wants to be assured that the "thank you" is not to be preserved, how about a box of home-made cookies with "thanks Doc" outlined in frosting on each cookie. These won't last to go into a chart! ..Maurice.
Dear Dr. Bernstein:
I hate to point this out, but your comment to Anonymous demonstrates a classic case of a doctor who doesn't listen. "A" just told you that he or she has already given non-note presents, then you suggest cookies. Did you even read the letter? Also, how do you seriously believe we can buy the idea that a "scanty" chart can possibly be "volumized" by personal notes from the patient? Come on. If the doctor isn't listening and taking good notes, a plethora a "thank yous" from the patient won't make up for it.
I recently bought a gift for my surgeon and plan on giving it to him soon. Why? Not only am I grateful for his medical help but I can also say he saved my life. I was a victim of domestic abuse and this surgeon was very supportive and caring towards me. If it wasn't for him I wouldn't be here today. He went beyond the call of duty. Too bad he is retiring soon because he is such a good man. I have thanked him before but feel a gift and a thank you note is appropriate for what he has done. He is truly an angel.
No one is addressing my concern: Should a patient give a doctor a substantial gift before they are about to embark on a lengthy, difficult, potentially life saving year of treatment and surgery? How is this interpreted? Would a doctor accept this? Would a doctor give any different attention to this patient?
Anonymous from Jan 20 2007: Very good question you ask. Gifts from patients to doctors are usually given for beneficent services already rendered. Gifts for past care would be acceptable to the doctor but I think most doctors have typical human feelings and would wonder about the propriety and ethics of accepting a gift prior to care. On the other hand, I am sure there are medical/surgical practices that even require some down-payment prior to rendering services, so what's the big deal about a pre-treatment gift? As I said a very good question. Personally, i would tell the patient, "thank you, but lets put this gift in escrow until next year when the treatment is finished and you are well. I would so much more appreciate receiving it then and I am sure you would be so much more happy to give it." How's that for the best physician response? ..Maurice.
I have given doctors who I thought gave exceptional care and really had a great bed-side manner gifts in the past. However, it has always been after treatment was rendered and not before or during. Usually I would give it to them on the last day of their treatment/visit or I would send them something within 2 weeks after the treatment was completed with a nice thank you note.
As far as giving gifts in the beginning or during treatment, I think it would be okay if it was of small value. Perhaps some baked goods for the doctor and their staff would be the best way to go. Let them know it is a token of your appreciation for the good job done so far.
Now the question is, what gift is within reason, or considered acceptable, to give to a physician as a token of appreciation for their services? We all know about cookies and cakes being okay, like at Christmastime for example, but what about free tickets to a baseball game, or a concert by a big celebrity singer? It is interesting that gifts from pharmaceutical companies are not acceptable, but sometimes acceptable from patients--it all depends, right?
If a patient wanted to give me a gift it should be after I accomplished something beneficial for the patient or showed some behavior in the interaction which warranted the gift. I don't think it is appropriate in ethical terms to present gifts to the doctor before the doctor-patient relationship is fully developed and the doctor has performed well. Given, before.. it may appear as and may well be.. a bribe! No doctor should be comfortable with that! ..Maurice.
Dr. Bernstein,
Thank you for your clarification. In my mind I was thinking that very same thing, that a gift given by a patient before treatment is rendered would indeed seem tantamount to bribery, but any gift given after treatment, if given without "cunning" as the aforementioned poet stated, is okay.
I gave my dr a chrismass gift and since i was changing providers i didnt think it was a big deal poor guy runs a round all day .i hope he used it but....it will be nice to know that he got it and appreciate it drs are human too whats wrong with showing them that you care now the watch is a bit effy .
I'm a PT who was given an expensive cell phone by a patient's parent. They are of Middle Eastern heritage and the father is primary spokes person. I have worked with their special needs child for 2 yrs now. Last year, the parents gave me a box of Godiva chocolates. When he handed me the holiday gift bag I thanked them both and set it aside looking forward to a tasty treat later. I would not see them until 2 wks later, as I work part-time. When I opened the bag the next day. I was shocked. I've never received/been offered anything with a price tag on it, over $10. This was way more $$. My efforts to contact the family were foiled by language barriers. I reported the problem to my admin. I understood the parent's level of gratitude because we were solving some critical issues related to the child's needs. However, I was sure that accepting this type of gift would be considered "unethical", "inappropriate" and "in conflict of interest" to my employment terms.
After 2 wks, my patient returned yesterday for regular PT services. The father spoke to me privately and told me he wanted me to have this gift and would mail or deliver it to my home, as necessary. I explained to him how gifts of lesser dollar value are considered "legal" among medical pros and reminded him of the Godiva gift, with a smile. Yet, this gift seemed important to him. I could not ask him, "Why a cell phone?" Because that wasn't the issue. I have one. But my Admin asked me that question. I told her it may have been related to the fact he was not able to hear on my phone when earlier in the year we were calling a key person regarding his child's care. However, I personally had no interest in this particular item. She said that he told her she had "insulted his dignity"! She was shocked and concerned. She suggested that I try to resolve the issue now that the gift had been returned. What do you think I should do?
Akua, PT
Akua, if I understand your narrative, and correct me if I am wrong, the father did speak with your administrator but the father was insulted and there was no resolution between them since communication between the two, if it had not as yet occurred, would have been my first suggestion. It is your administrator's responsibility to help settle the issue since she is the one who enforces the professional guidelines.
Since this meeting was unsuccessful and the gift has already been returned, your task is to continue to provide the best attention and care to your patient and further educate the father that we have cultural requirements in our culture as other cultures have their own requirements and that professionals must reject "expensive" gifts from their patients but that the return of the gift is just part of our culture and that your attention and care for the patient will not change.
If you were living in the country of the family's culture, you could occasionally be faced with upsetting conflicts in their culture, different than your's now, and this is something the family should understand.
Perhaps other visitors to this thread might contribute other suggestions. ..Maurice.
I guess accepting gifts are Ok but only AFTER THE CARE FOR THE PATIENT IS DONE. Otherwise there shouldn't be any gifts.
Thank You gifts are common practice among patients and some patients even get angry if doctor doesn't accept thank you gift.
Post a Comment
<< Home