The festive season is almost upon us. It’s quite possible, even probable, that if you’re a competent and personable doctor, you’ll have patients who’ll want to give you a gift. But should you accept, or are there times when it would be wiser to refuse?
It’s a tricky subject that hasn’t gained the same attention as gifts or monies from pharmaceutical companies. And yet conflicts of interest can be an issue in patient gift-giving as well. One particularly egregious case is that of the Harley Street psychiatrist Peter Rowan, who was struck off in 2011 after accepting a $A2.1 million legacy from a patient, on top of $A260,000 worth of cheques. Explaining its reasons for deregistering the doctor, the fitness-to-practice panel noted that the patient had been given excessive doses of benzodiazepines before her death, and that the large gifts had clouded Rowan’s medical judgement.
Even if you don’t have any patients offering you millions of dollars, you can still find yourself on the receiving end of a gift that is rather more than the traditional box of chocolates. There is little official guidance on the issue. The Medical Board of Australia’s Good Medical Practice – Code of Conduct merely says that doctors should not encourage patients to “give, lend or bequeath money or gifts that will benefit you directly or indirectly”. But individual hospitals or state health services may have their own rules. For example, NSW Health sets a limit on the monetary value of any accepted gift of no more than $75, and stipulates that a gift register should record any gift given to a staff member.
Mostly, patients give gifts to show genuine gratitude, but doctors should be aware of other possible motivations. It could also be to show inappropriate affection, or it could because the patient wants something from you – preferential treatment, or some form of therapy you wouldn’t normally give.
Most would agree that accepting a token gift as an expression of gratitude is acceptable, particularly when refusal could be embarrassing and harmful to the doctor/patient relationship. But if there is any risk that a gift could influence a doctor’s decision-making, or could be perceived as such, the wisest move would be to decline, as gracefully as possible.
If that’s not possible without embarrassment or patient resentment, other solutions may be possible. Cash gifts could be given to charity, for example, or to a hospital fund.
Timing should be taken into consideration as well. Being offered a gift at Christmas time is a time-honoured ritual, but if you were offered something out of the blue at some other time of the year, you might want to be a little more cautious.
The American Medical Association suggests that before accepting a gift, doctors should reflect on whether they’d be comfortable with their colleagues or the general public knowing about it. That seems like a good rule of thumb: if you wouldn’t want anyone finding out about it, it’s probably best to gracefully decline.