A Doctor's Gift to the Patient: Is it Ethical? Is it Professional?

It is 5 pm on Friday afternoon. After 2 hours on the telephone trying (and failing) to get her insurance plan to pay for her medication refill, I reached into my pocket and handed the patient $30 so she could fill the prescription. It seemed both kinder and more honest than sending her away saying, “I’m sorry I can’t help you.” While I hardly expected a commendation for such a simple act of kindness, I was completely surprised to find myself being reprimanded for my “unprofessional boundary-crossing behavior” after the resident I was supervising shared this incident with the clinic directors. This allegation of an ethics violation was not only personally painful; it also raised important, controversial, and timely questions about appropriate professional roles.

This is a brief excerpt from an article by Gordon D. Schiff MD in the "Piece of My Mind" section of the September 25 2013 issue of the Journal of the American Medical Association.  

Unfortunately, the simple story as presented by Dr. Schiff becomes much more complicated when one considers all the ethical and professional possibilities which such a gift of money to pay for filling a prescription presents as an example. Some possibilities may relate directly to the behavior of the patient. For example, couldn't that gift instead of going toward the patient's healthcare be used by the patient to purchase an illicit drug or alcohol to sustain a hidden drug habit or alcoholism? Couldn't that gift begin an ongoing expectation by the patient for further "contributions" by the doctor on subsequent visits? 

And then there is the issue of crossing the current line of a doctor moving from a professional relationship towards a patient to a more personal relationship. Though developing some personal financial relationship or  any intimate personal or sexual relationship is strictly forbidden by current professional ethics and medical practice regulatory laws, where does giving the patient a gift cross the line of strict professional behavior such as that of primarily self-interest? For example, would giving the patient a bouquet of flowers for her birthday be getting "too close" to the patient or would giving a piece of jewelry of more ethical concern?

In these days of medical practice with the limiting of physician paternalism and stressing patient autonomy and with limitation of time with patients due to large patient loads and attention to professional regulation to prevent unprofessional closeness, a "detached, arms-length, uncaring relationship" may unfortunately be encouraged. But is that we all want from our doctors? Shouldn't there be some signs of care and interest in the patient beyond that which is purely clinical? It will always be society which should finally set the standards for medical care and how one should look at that $30 gift provided by that doctor.

Do you think it was appropriate for the clinic directors to reprimand the physician for what was done? If the gift is looked upon as charity would that make the action of the doctor more professional?  As the patient, how would you look at such a gift or even some other gift from your doctor?

Addendum: With regard to "gifts" in medical practice, how about the issue of whether patients should be giving gifts to their physicians.  I cover that issue and followed by visitor commentaries in a blog thread titled “'Pick one.. it’s Yours': Patient Gifts to Their Doctors"

Graphic: From Google Images and modified with ArtRage and Picasa3.