Tips on accepting (and refusing) gifts from patients

Every clinic I’ve worked at has always graciously accepted gifts from patients. Many patients just want to show their gratitude and this holiday season is the occasion… or is it? Most provincial colleges of physicians and surgeons frown upon this as a “boundary issue” and a potential slippery slope of professional misconduct. There’s legitimate concern over a box of stale re-gifted chocolates? Really?? This issue of receiving gifts from patients appears to be a lot grayer than you might expect. I’ve had a few gifts given to me over the years that were about 50 shades of gray… (including an over-sized electric knife and a bathrobe with an embroidered hotel insignia to name a few). Read: Ghosts of Christmas epidemics past All provincial colleges of physicians and surgeons have a written policy that goes something like: A token or “small, and of minimal monetary value” gift is allowed. Acceptance is discouraged if a physician feels any discomfort in the interaction when the gift is presented. They reference that we must “acknowledge the impact on boundaries and the patient-physician relationship.” Some gifts are fully benign and wouldn’t be challenged. A simple Christmas card, some homemade cookies, a gift basket for the staff to share, these are simple gestures of thanks and would be insulting to flatly refuse. On the polar opposite, there could be a patient demanding to give a large amount of cash in hopes of “buying” a unique and preferred relationship with a physician. There would not be a lot of argument that this is inappropriate and must be refused. But what if it is somewhere in the middle of these extremes? Tricky examples could include: The wealthy son of a patient with a cancer you fortuitously caught early and saved his life. A $250 gift certificate for your favourite restaurant. A longstanding elderly patient is moving out of province and is grateful for all the many years of your exemplary care. They’ve been a wonderful patient and you have had an effective, therapeutic and professional relationship for decades. On their last visit to you, to say goodbye, they leave a case of very expensive vintage wine (estimated value $500). A large family offers you a free week at their condo in Maui whenever you and your family want “no strings attached.” They know how hard you work and all the time you spend away from your family and they want you all to enjoy their generosity. Everyone in the family loves you!! (Estimated value $2000) Of course you could flat out refuse, or as we are being instructed by our colleges, “not refuse, just graciously not accept.” Certainly. Absolutely. Come on… we work so hard and get so few ‘perks.’ How can this be wrong when it feels so good? It’s a slippery slope. That’s the problem!! Read: ER tales: Christmas breaks We're all humans, and therefore easily tempted. Innocent actions aren’t always so innocent. There’s a power differential in the physician patient relationship and professional boundaries are constructed to protect patients. Boundary ‘crossings’ are considered minor and might be related to misunderstandings or misjudgements. It can happen on both sides of this relationship. OOPS! Boundary ‘violations,’ however, are unethical. They’re considered exploitative and damaging and would be grounds for allegations of professional misconduct. So could offering or accepting a gift be considered an unethical boundary violation? Once the gift is accepted, does the relationship change? Here lies the dilemma. Who decides? What is the appropriate action? I find a lot of patients leave gifts at the reception desk so as “not to bother the doctor.” They’re only seen by me well after the fact. Not an excuse, but another layer of dilemma that makes this gift receiving even more problematic. I can’t blame the staff for taking what a patient drops off. Paraphrasing Judith Marois, in a very insightful article in a 2010 British Columbia Medical Journal: When declining a gift • Explain the reason you are declining the gift. • Emphasize that declining the gift is not equal to rejecting the giver. • Record gifts offered. When accepting a gift • Explain that the acceptance of the gift does not alter your relationship or affect treatment quality. • Discuss accepted gifts with your colleagues to promote accountability and transparency. • Record gifts received. So physicians, be a bit wary of givers of gifts. The too big-ticket items as well as the smells-like-turpentine homemade booze. Have a great holiday season and get whatever break you can and enjoy! Dr. Ted Jablonski is a singer-songwriter, emerging playwright and neophyte poet who has recently retired his family practice to focus on sexual medicine and transgender health in Southern Alberta. He now finds himself advising medical students at the Cumming School of Medicine and back on the front line trenches leading the charge against the COVID pandemic.

Tips on accepting (and refusing) gifts from patients

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