Humanizing the Physician-Patient Relationship

Photo by National Cancer Institute on Unsplash
 INTRODUCTION
 Gift-giving patients or their families to physicians has happened since there were and physicians, in many places, it’s still quite common. It’s also potentially problematic, the why how of it offer important insight into physician-patient relationship human relationships more broadly. Yet ethicists, regulators, public have not paid much systematic attention. In United States, no federal state legislation directly addresses it. Only past two decades did American Medical Association (AMA) release guidance about That guidance, which permits accept certain gifts under circumstances, namely, when will influence medical judgment cause hardship gift-giver, is vague incomplete – indeed, all 200 words.[1] Other physician professional organizations little add.[2] A few academics opinion columnists studied reflected psychology gift-giving -receiving recommended everything from categorical rejection patient gifts[3] erring side accepting them, provided they are modest value, motivation behind them can be discerned.[4] However, insufficient attention been where those significance clinic-, hospital- other systems-level ethical safeguards.
 ANALYSIS
 When deciding whether a gift family, must balance possibility that could cloud judgment, lead favoritism, exploitation, slippery slopes, pressure give, perhaps even debase meaning treatment, against prospect increase trust satisfaction, as well empower respect autonomy culture.[5] Performing this harm-benefit calculation case challenging time-consuming. Unsurprisingly, opt simply tell would-be appreciate sentiment, but, rule, gifts. I submit do because unaware meaningful giving for anyone disadvantaged position with recipient. They may know simple accountability mechanisms institute prevent possible adverse consequences context physician-patient-family relationship. Unfortunately, instances would led net benefit foregone.
 It my belief consensus quickly formed types clearly wrong accept. Few defend who agrees use patient’s villa Bahamas welcomes expensive jewelry lewd photos. The timing intent matter. forgive accepted modestly valuable voucher eat at restaurant while eligibility transplant was being debated after had run out opioid painkillers denied prescription renewal. On hand, doubt Charles Weijer College Physicians Surgeons Prince Edward Island, views “boundary crossing,”[6] demand an orthopedic surgeon turn down happy picture pediatric drew recovering hip injury resuming sports. unlikely criticize oncology team graciously receives fruitcake baked sister elderly cancer decision made agreed to, around Christmastime, initiate another round chemotherapy.
 These refusals rejecting gifts, things considered, seem cruel. But might disagreement what constitutes gift: tangible object (are heartfelt thank-yous hugs “gifts”?) something requires actively something, e.g., get plane. disagreements definitions partially underlie practice. Suppose sparsely populated, heavily wooded part Maine takes upon himself sack apples his orchard internist, regularly waives fees cannot pay make house call any time night. case, internist consider gift. He think payment re-payment either. exist some in-between category, like knitted slippers brought whose culture “thank you” seldom said.
 clearly, widely perceived substantial gift-like character. Should they, least, rejected? don’t so. act sort ritual gradually closeness.[7] Perhaps shy wife previously sent chocolates Christmastime come see extended family. he needs so feel comfortable talking erectile dysfunction. Gifts expressions caring.[8] Texan imagines her younger physician, whom she known thirty years often sees grocery store, son asks prepare homecoming mum (traditionally chrysanthemum flower corsage) children’s school dance. doing give purpose, useful, own children moved away. Giving provide sense control help if less power imbalance exists between physician. young judge, used control, misdiagnosed rheumatoid arthritis, now struggling terms Lupus. correct diagnosis moderately-priced bottle scotch restores confidence pride to.
 undoubtedly providers receive gift, interpret sign valued. While practice medicine expect times, ERs ICUs overwhelmed viral pandemic,[9] threatens continue working, most anything (within reason) bolsters resolve considered good. There obvious distinction satisfaction normally seeing recover thanked smiled small “token” plate homemade cookies.
 point one. Many advocate should personal, emotionally invested patients, care compassion ways oaths fully capture.[10] This dynamic particularly primary continues long periods. According one Israeli study, wish akin friendship. Those felt such satisfied than believed business-like.[11] precedent “friendship unequals” goes back least Erasmus, five hundred ago.[12] good reasons draw line before friendship, but builds intimacy, intimacy does cross over inappropriate relationship, sexual romantic chance improve healthcare outcomes through improved mood early disclosure problems, done. prima facie duty patients.[13] Most want traditions preferences. suspect examples above lot good, significant harm, including making estranged community, impeding future care.
 receiving subject scrutiny penalty. better knew harm might. document receive.[14] enable detect particular increasing frequency lavishness changing markedly character, warrant maintain “Gift Log” maintained common everyone clinic relevant hospital department available administration audit. Investigation necessary given (and accepted) explicable context, near holiday season treatment milestone achieved. possible, shared communally, placing fruit baskets staff room. artwork, displayed walls.
 Others encouraged hold accountable preferential seemingly priority appointment bookings. Appearances matter appearance impropriety affect public’s medicine. already changed nurses reproach violate standard care,[15] extension trend. Depending set-up practice, member designated politely declining ought declined. Staff members full view future. rebuff times suggest donate charity instead. practices hospitals develop policy consultation avoid needlessly both doctor pressuring flexible account crucial element provider-patient cultural nuances setting. Psychiatrists, work vulnerable need vigilant gifts.[16]
 CONCLUSION
 Though we tend health innovation occurs urban centers spreads outward, big-city learn rural colleagues personalized patient-physician relationships. value only example. Normalizing acceptance appropriate restricted circumstances added shining spotlight dubious ones. By bringing fairly open it, create policies persons, abuse, deconstruct stereotype austere detached reason safeguards put place, community always re-evaluate period, individual based environment. Gift-giving, especially monetary recognized culturally gesture far beyond value. best governed reasonable policies, banned altogether.
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 [1] Council Ethical Judicial Affairs. “Ethics Patient-Physician Relationships.” AMA Code Ethics, 11. Chicago: Association, 2021. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-1.pdf.
 [2] Sulmasy, Lois Snyder, Thomas A. Bledsoe. “American Ethics Manual.” Annals Internal Medicine 170, no. 2_Supplement (January 15, 2019): S1–32. https://doi.org/10.7326/M18-2160; Committee Bioethics. “Pediatrician-Family-Patient Relationships: Managing Boundaries.” Pediatrics 124, 6 (December 1, 2009): 1685–88. https://doi.org/10.1542/peds.2009-2147.
 [3] Weijer, Charles. “No: Debase True Value Care.” Western Journal 175, 2 (August 2001): 77.
 [4] Lyckholm, Laurie J. “Should Accept From Patients?” JAMA 280, 22 9, 1998): 1944–46. https://doi.org/10.1001/jama.280.22.1944; Spence, Sean “Patients Bearing Gifts: Are Strings Attached?” BMJ 331, 7531 22, 2005): 1527–29. https://doi.org/10.1136/bmj.331.7531.1527; Gaufberg, Elizabeth. Family Physician 76, 3 2007): 437; Caddell, Andrew, Lara Hazelton. “Accepting Patients.” Canadian 59, 12 2013): 1259–60.
 [5] See commentators Drew, Jennifer, John D. Stoeckle, Andrew Billings. “Tips, Status Sacrifice: Gift Doctor-Patient Relationship.” Social Science & 17, 7 1983): 399–404. https://doi.org/10.1016/0277-9536(83)90343-X.
 [6] Island. “Respecting Accessed April 4, https://cpspei.ca/respecting-boundaries/.
 [7] Atlantic’s Marketing Team. “What Gifting Rituals Around Globe Reveal About Human Nature.” Atlantic, 2018. https://www.theatlantic.com/sponsored/hennessy-2018/what-gifting-rituals-around-globe-reveal-about-human-nature/2044/.
 [8] Parker-Pope, Tara. “A Gives Right Back? Itself.” New York Times, December 11, 2007, sec. Health. https://www.nytimes.com/2007/12/11/health/11well.html.
 [9] Harlan, Chico, Stefano Pitrelli. “As Coronavirus Cases Grow, Hospitals Northern Italy Running Beds.” Washington Post. https://www.washingtonpost.com/world/europe/italy-coronavirus-patients-lombardy-hospitals/2020/03/12/36041dc6-63ce-11ea-8a8e-5c5336b32760_story.html.
 [10] Frankel, Richard M. “Emotion Physician-Patient Motivation Emotion 19, (September 1995): 163–73. https://doi.org/10.1007/BF02250509.
 [11] Magnezi, Racheli, Lisa Carroll Bergman, Sara Urowitz. “Would Your Patient Prefer Be Considered Friend? Preferences Health Education Behavior 42, (April 2015): 210–19. https://doi.org/10.1177/1090198114547814.
 [12] Albury, W. R., G. Weisz. “The Erasmus Humanities 27, 1 (June 35–41. https://doi.org/10.1136/mh.27.1.35.
 [13] Beauchamp, Tom L., James F. Childress. Principles Biomedical Ethics. 7th edition. York: Oxford University Press, 2012.
 [14] Caddell Hazelton, 2013.
 [15] See, e.g. Peplau, Hildegard E. Glance Back Time: Nurse-Doctor Nursing Forum 34, (1999): 31–35. https://doi.org/10.1111/j.1744-6198.1999.tb00991.x Ahmad, Ahmir. Doctor-Nurse Relationship: Time Change?” British Hospital (2005), September 2013. https://doi.org/10.12968/hmed.2009.70.Sup4.41642.
 [16] Hundert, “Looking Horse Mouth: Gift-Giving Psychiatry.” Harvard Review Psychiatry 6, 114–17. https://doi.org/10.3109/10673229809000319.