The practice of patients giving gifts to their physicians is as longstanding as medicine itself. But the giving of gifts to those in positions of authority has recently come under scrutiny. Bill and Hilary Clinton, for example, have come under attack for accepting gifts from admirers during the last year of their White House stay. Medicine involves a fiduciary relationship, with patients relying on physicians' advice and expertise. If they present physicians unsolicited gifts, is it ethical to accept them? I believe it is, with a few important caveats.
First, let me distinguish clearly between gifts from individual patients and those offered by drug companies, device manufacturers, and other commercial ventures. There is a wealth of evidence that such corporate gifts can influence the behavior of health care providers, often in ways that run counter to good patient care.1
A patient's intent in giving a physician a gift is relevant. There may be 3 possible motives for gift giving: influence, pure beneficence, and appreciation. No one can ever know with certainty the motive behind any action, but subsequent behavior after the gift has been given may provide a clue.
Giving a gift to influence an outcome is a bribe, and as such, it is unethical. The increasing tendency of hospitals to attract donor money with promises such as “access to the best” is disturbing. The implication here is that a sizable donation will result in special attention or the ability to “jump the queue.” Some institutions even distribute “donor cards” to give patients tangible evidence of their special status. Individual physicians have also been involved in this practice, which cheapens the physician and destroys the trust inherent in a healthy doctor-patient relationship.
But some people are simply generous by nature. Gifts to the mail carrier, the newspaper carrier, the hairdresser, the physician, and others in their lives are just a part of their personality. They derive pleasure from the act of giving itself. Such behavior is inspirational and should not be thwarted.
What about giving gifts in appreciation of a previous action or in celebration of a healthy relationship? Although this motive is more focused than pure beneficence, it does not aim to change future behavior. To understand the appropriateness of gift giving in this situation, we need to consider the nature of the doctor-patient relationship.
Some people are simply generous by nature
Some people hold that the degree of involvement between a physician and patient should be a purely neutral and objective one. Such pure objectivity would preclude acts of sentiment—such as giving a gift out of appreciation—as irrelevant and damaging to the neutrality of the association. But an alternative school of thought imbues the doctor-patient relationship with attributes such as compassion and trust. These qualities stretch the relationship beyond a strictly neutral and impersonal one. Pellegrino and Thomasma have described the bond between a physician and individual patient using the concept of a special type of friendship.2(pp51-60) This involves recognizing personal values and the provision of information and access to treatment. Friends recognize the special nature of their relationship, and in this context, presenting gifts is both natural and honorable.
Provided that patients are not trying to influence their relationship with their physician, the doctors should accept the gift with a smile, send a thank-you note, and move on.
Gifts from patients with no strings attached are acceptable
Gordon Southgate
Notes
Competing interests: None declared
References
1. Lexchin J. Interactions between physicians and the pharmaceutical industry: what does the literature say? CMA J 1993;149: 1401-1407. [PMC free article] [PubMed] [Google Scholar]
2. Pellegrino ED, Thomasma DC. For the Patient's Good: The Restoration of Beneficence in Healthcare. New York: Oxford University Press; 1988.
FAQs
Some gifts are offered as an expression of gratitude or a reflection of the patient's cultural tradition. Accepting gifts offered for these reasons can enhance the patient-physician relationship. Other gifts may signal psychological needs that require the physician's attention.
Should physicians accept gifts from patients? ›
Provided that patients are not trying to influence their relationship with their physician, the doctors should accept the gift with a smile, send a thank-you note, and move on.
Is it appropriate to give your doctor a gift? ›
Physicians should decline gifts that are disproportionately or inappropriately large, or when the physician would be uncomfortable to have colleagues know the gift had been accepted. Not allow the gift or offer of a gift to influence the patient's medical care.
Is it unethical to give a patient a gift? ›
Consider the intent, value, and nature of any gift you are offered and decide whether to accept it on a case-by-case basis. It is OK to accept a small token of appreciation so long as it does not compromise the patient or therapy process, most professional organizations agree.
Is it ethical to accept gifts from clients? ›
The client may feel a sense of pride and satisfaction from being able to thank the worker with a gift. However, if the client feels exploited or manipulated—or if the client receives inappropriate services as a result of gift-giving—then encouraging or accepting the gift would be unethical.
Is it considered ethical behavior for a physician to accept gifts from medical companies? ›
Decline any gifts for which reciprocity is expected or implied. Accept an in-kind gift for the physician's practice only when the gift: will directly benefit patients, including patient education; and. is of minimal value.
Why should you accept gifts? ›
In the long run, we can't stay emotionally healthy without accepting gifts, both concrete and intangible. Refusing to receive leaves us chronically empty, prone to addiction, obsession, codependency, or an eternal psychological hunger that's never quite satisfied.
Why did the doctor not want to accept the gift? ›
The gift is a “tip” for “more than standard” service. “This is why doctors do not automatically reciprocate—implicitly or explicitly they understand that the “gift” of their treatment initiated the process. That is, they 'gave' first.” A gift arriving unexpectedly must be seen with suspicion.
How much can you gift a doctor? ›
Medical staff gifts have a limit of $25 per gift, adjusted each year, with no aggregate limit.
Can you give a patient a gift? ›
Laws prohibit individuals and healthcare organizations from purchasing anything that persuades or influences a patient's healthcare. What we think of as kindness may be viewed as a type of kickback or incentive.
In GIFT, the ovum collected from the donor or the woman herself is mixed with sperms and is transferred to the fallopian tube of the recipient or ownself. It is used in the cases where a female is unable to produce an ovum but can provide a proper environment for fertilisation or in case of sperm dysfunction.
Why shouldn't nurses accept gifts from patients? ›
One reason accepting lavish gifts is an issue is that it might signal to your colleagues that you practice preferential treatment, which is unprofessional conduct and could hurt patient safety.
What is one reason why a health aide should not accept gifts? ›
What is one reason why a home health aide should not give or accept gifts? Some clients who give gifts many believe they deserve special treatment. Create a sample schedule for a two-hour morning visit to an elderly client named Mrs.
Is it okay to give and accept gifts from patients? ›
A small gift such as baked goods is probably fine. But an extremely valuable gift should be declined, especially if it is likely to cause a financial hardship for the patient or the patient's family.
What to do if a client gives you a gift? ›
Thank your client. Then gently share that you need to confirm if you're able to accept their thoughtful gift with your professional body. Keep notes. Discuss the reasons you accepted, refused, or offered a gift.
What is the gift rule in ethics? ›
The Gifts Rule allows you to accept gifts, including discounts, offered to the public, to all federal employees, or to members of a group or class in which membership is unrelated to congressional employment.
Can doctors accept gifts from former patients? ›
The acceptance of a gift must not affect, or be seen to affect, the way a doctor treats or prescribes for a patient. “It's a matter of professional discretion, and doctors must be prepared to explain their decision. Ultimately, gifts should be refused if they could be seen as an abuse of trust.
Can healthcare workers receive gifts from patients? ›
Although it's unacceptable for a nurse to accept a gift of large monetary value, smaller tokens of appreciation might be suitable. Dr. Nikola Djordjevic, MD, co-founder of MedAlertHelp.org, agrees. "I don't think it's okay to accept any major gift from patients.
Can doctors accept gifts for referrals? ›
In short, you should not give or accept gifts to or from referral sources (especially those referring federal program business) unless the gift is truly nominal, is clearly and completely unrelated to past or future referrals, or is very unlikely to influence referrals.
Can physical therapists accept gifts from patients? ›
A gift of monetary significance is generally disallowed by therapists and their professional associates. State licensing boards may also prohibit the therapist from giving or receiving a gift of monetary value with their patient. Any gift given to the therapist should have low to no monetary value.
