I’ve received gifts out of gratitude for my medical care. One memorable instance occurred when I was on a scuba diving trip in St. Croix during residency. One of my dive partners, whom I had met on the trip, had a seizure as we disembarked the dive boat. He and the rest of the crew knew I was a doctor and let me handle the situation.

I made sure he was safe, called paramedics, and accompanied him to the hospital to ensure he had the best care. When I returned to work, a dozen cupcakes (from a well-known bakery in town) and a bouquet of flowers awaited me from my dive buddy and his wife.

Although he was not my patient, they expressed their gratitude through this kind gesture.

I’ve also given gifts. I often give one to my patient after I deliver her baby. If a patient dies, I will send flowers to the family. I have baked cookies or cinnamon rolls for my veterinarian and his staff as a way to express my gratitude. It’s nice to receive (and give) gifts in our work as physicians. But there are lines that we should be wary of crossing.

 

What are the motives?

Patients offer gifts to physicians for many reasons. However, because there are no universal guidelines about receiving gifts from patients, physicians are often uncertain about handling the issue. Some believe that accepting gifts from patients can influence their clinical judgment, while others argue it can enhance the patient-physician relationship.

Some patients give gifts to express their gratitude or reflect on their cultural traditions. Accepting small gifts for these reasons can enhance your relationship with the patient.

Receiving small tokens of appreciation from grateful patients is usually reasonable and polite. On the other hand, refusing a much thought-out gift may cause the patient embarrassment and disappointment.

However, some gifts can signal red flags, as patients may have an underlying motive. Expensive gifts or cash can often be given to influence care or secure preferential treatment.

Sharma A, Johnson L-M, Brown AC, et al. An extravagant gift from a grateful patient. Pediatrics. 2018;141(6):e20172837.

As a result, these gifts can undermine physicians' obligation to provide fair medical treatment services to all patients; accepting them will likely damage the patient-physician relationship.

 

Some patients may want to change that relationship, hoping to gain a professional colleague or social friend. Con­sciously or not, a gift may be a bribe that comes with an expectation of reward or acknowledgment.

 

Expert opinions

 

Several views exist on whether physicians may accept such gifts from their patients.

Joel Dunnington, MD, a radiologist who retired in 2014 from the University of Texas MD Anderson Cancer Center in Houston, testified in the late 1990s to endorse banning all patient gift-giving to physicians.

Wolinsky H. Do you accept gifts from patients?. MedPage Today. December 5, 2019.

He feared patient gifts could lead to such inequities as queue jumping by the super-rich such as the Saudi royals who got preferential treatment for kidney transplants at the Presbyterian-University Hospital in Pittsburgh following substantial donations to the university in the 1980s.

 

A policy statement form the American Academy of Pediatrics (AAP) clarified the organization's stand on gifts from patients.

Pediatrician-family-patient relationships: managing the boundaries. Pediatrics 2009;124(6):1685–1688.

 

Accepting modest gifts from patients does not involve a serious conflict; in fact, refusal of a gift may constitute a social or cultural affront.

The AAP policy also states, “When the pediatrician feels uncomfortable with a gift that a family insists on delivering, he or she must voice the concern and suggest acceptable alternatives, such as a charitable donation in the pediatrician's name."

The American Medical Association (AMA) suggests that “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.”

Opinions on patient-physician relationships. In: AMA Code of Medical Ethics. American Medical Association; 2016.

 

Many institutions have established policies on gifts. For example, a hospital may prohibit employees from accepting gifts with a monetary value of>$25 or items of >$100 when a department or a service shares them.

 

Assessing a gift’s value

Small gifts such as a homemade craft, handwritten card, or baked goods are most likely appropriate. An extremely valuable gift such as jewelry or anything that is directly correlated to monetary value should be declined, especially if it’s likely to bring financial hardship for the patient or their family.

A good rule of thumb to determine if the gift is appropriate is whether you’d be comfortable having your colleagues know about it. If there's any discomfort, it's probably best to decline it.

 

How to politely decline a gift

 

To avoid hurt feelings, thank them for the gift, politely communicate why you can’t accept it, and assure them that this doesn’t change your relationship in any way.

If the gift truly had no strings attached, most patients will understand.