Sometimes patients are so thankful for a doctor’s care, they want to express their gratitude in the form of a gift and may even bequeath money or property.
However thoughtful on behalf of the patient, this situation can throw the most experienced doctor into a tailspin about whether accepting the gift is ethical or legal and can potentially lead to a complaint.
A GP member found themselves in this predicament after a female patient*presented to her surgery feeling mildly unwell with some pelvic pain and asked to be referred to a gynaecologist.
The doctor decided to perform a pelvic examination on the patient to check for bleeding and any other abnormality. She found the patient had forgotten to remove a tampon, which could have caused toxic shock syndrome. The GP removed the tampon and referred her to a gynaecologist.
Six months later, the patient’s daughter presented to the doctor and offered her a $400 spa voucher to thank her for saving her mother from a potentially life-threatening condition, such as toxic shock.
She was adamant she should accept the gift and the doctor felt to refuse would be interpreted as offensive, so she called us for medico-legal advice.
Code of Conduct: dos and don’ts
While accepting gifts from patients does not necessarily breach boundaries, doctors should carefully consider the implications before accepting gifts and how it may affect their ability to provide good healthcare.
As these situations are not black and white, a medical adviser discussed with the doctor the guidance in the Medical Board of Australia‘s Good medical practice: A Code of Conduct which does not rule out receiving a gift from patients within defined boundaries. It recognises there may be some circumstances when it is acceptable, bearing in mind the value of the gift, reasons for giving and the doctor’s attitude and demeanour.
The code outlines how doctors can ensure honesty and transparency in financial arrangements with patients. Doctors must not encourage patients to give, lend or bequeath money or gifts that will benefit them directly or indirectly. Always be mindful of the power imbalance in the doctor-patient relationship and the potential for changed expectations from patients following acceptance of a gift.
Complaint to regulator over gifts
Doctors should also be aware that accepting a gift from a patient can also trigger concern from their family members and potentially result in a complaint being made.
In one case, a GP had been treating his elderly male patient for over a decade. The doctor’s wife, also a GP, had treated the patient’s wife in that time. To show his appreciation for the care he and his wife had received over the years, the patient gave one or both doctors two bottles of wine about three or four times a year and, on one occasion, a meal voucher.
The patient’s family members believed the GP had failed to observe appropriate professional boundaries and were also concerned with the GP’s overall clinical care of the patient. The family members lodged a complaint with the state’s complaints body.
In considering whether a finding of unsatisfactory professional conduct was appropriate, the Professional Standards Committee considered among other factors:
- The varied interpretations and implications of the gift-giving, such as monetary value, nature and frequency of the gifts.
- whether the GP attempted to discourage or return the gifts.
Ultimately, the committee found in favour of the GP on all aspects of the complaint and did not consider that accepting a gift would necessarily breach the Code of Conduct.
The committee found the GP had not encouraged the gifts. However, they noted it would have been desirable for him to have held a conversation with the patient about why the gifts were given and reinforcing to him that they were not necessary. The committee believed that failing to do so could not be described as improper or unethical based on the context of their relationship and the patient’s desire to give gifts.
Other factors to consider
Doctors should also be aware of their practice or hospital’s policies and procedures on accepting gifts from patients.
A good rule of thumb to follow is to perform the ‘peer test’ – which means determining how your colleagues would feel about it if you accepted the patient’s gift and whether they would deem it appropriate.
Doctor accepts voucher
In the case above, the doctor decided to accept the spa voucher and made notes in the patient’s record about the reason for the gift and a description of the gift. Any records should also provide evidence of impartial treatment (both financially and clinically) following the acceptance of any gift.
- While accepting gifts from patients does not necessarily breach boundaries, doctors should carefully consider the implications and how it may affect their ability to provide good healthcare.
- Never encourage a patient to give, lend or bequeath money or gifts that will benefit you directly or indirectly.
- Check your practice or hospital’s policies and procedures regarding accepting gifts from patients.
- Consider how a patient’s family may interpret your acceptance of a gift.
- Perform a ‘peer test’ to gauge how your colleagues would feel about your acceptance of a patient’s gift.
- If you decide to keep a patient’s gift, ensure you document the reason for the gift, a description of the gift and your acceptance of the gift in the patient’s medical record.
*Certain information in this case has been de-identified to preserve privacy and confidentiality.