Accepting gifts from patients okay?

June 4, 2013

Question:

Jennifer,

I receive gifts from patients sometimes and never know what to do or whether it is ethical or legal for me to accept a gift.  What is your take?

Thanks,
Dr. A

Answer:

Good question.  While there are no laws I am aware of prohibiting acceptance of gifts from patients, I am aware of hospitals and other institutions that have adopted private policies disallowing acceptance of gifts for a number of reasons - potential influence, favoritism, disputes or jealousy amongst colleagues. For those not working for a hospital or institution banning free gifts and looking for guidance on when it is acceptable to accept a gift from a patient, the AMA has an ethical opinion directly on point, as follows:

Opinion 10.017 - Gift from Patients

Gifts that patients offer to physicians are often an expression of appreciation and gratitude or a reflection of cultural tradition, and can enhance the patient-physician relationship.

Some gifts signal psychological needs that require the physician’s attention. Some patients may attempt to influence care or to secure preferential treatment through the offering of gifts or cash. Acceptance of such gifts is likely to damage the integrity of the patient-physician relationship. Physicians should make clear that gifts given to secure preferential treatment compromise their obligation to provide services in a fair manner.

There are no definitive rules to determine when a physician should or should not accept a gift. No fixed value determines the appropriateness or inappropriateness of a gift from a patient; however, the gift’s value relative to the patient’s or the physician’s means should not be disproportionately or inappropriately large. One criterion is whether the physician would be comfortable if acceptance of the gift were known to colleagues or the public.

Physicians should be cautious if patients discuss gifts in the context of a will. Such discussions must not influence the patient’s medical care.

If, after a patient’s death, a physician should learn that he or she has been bequeathed a gift, the physician should consider declining the gift if the physician believes that its acceptance would present a significant hardship (financial or emotional) to the family.

The interaction of these various factors is complex and requires the physician to consider them sensitively. (I, II)

So, taking from the AMA opinion, really whether to accept is a factor test implemented by your personal sense of appropriateness given the circumstances. Still not sure if you can keep your gifts means you probably received something inappropriate and you already had your answer before asking!