Should family physicians accept gifts from patients?

I think it is safe to say that most family physicians have received gifts from patients, even if it was only a box of chocolates, an apple pie, or a bottle of wine. Although only 20% of physicians say they have received gifts,1 it would not surprise me if the opposite were true. Indeed, it is unusual for a family physician not to have accepted gifts of some kind. In fact, several codes of ethics allow physicians to accept expressions of gratitude in the form of modest, reasonably priced gifts. But what constitutes a modest, reasonably priced gift? For some, accepting a sugar pie is harmless and simply attests to a patient’s gratitude. Then what about a bottle of wine, tickets to a football game, or an invitation to go on a cruise? Obviously, it depends on the bottle, the tickets, and the cruise. A Château d’Yquem and a homemade wine do not have the same value or the same significance; neither do an invitation to the Grey Cup and an invitation to a local high school game; or a trip to the Antilles and a spin around the lake in a 16-foot aluminium runabout during the local fishing festival. Everyone would agree that the Château d’Yquem, the Grey Cup tickets, and the trip to the Antilles are not modest or reasonably priced. However, it is all relative: the cost of a bottle of St-Georges might not be a big deal to you, but it could be the weekly savings of a family living hand to mouth. An Alaskan cruise might seem excessive, but it might be a reasonable gift from a wealthy construction contractor. In fact, it is relatively simple to determine whether a gift being offered to you is of modest and reasonable value. Would you, in turn, offer it to the care workers or receptionists in your practice? After all, don’t they deserve it as much as you do? If you would hesitate, then there is something more there. Some say that it is best to systematically refuse any and all gifts. Perhaps, but that is easier said than done and not always appropriate. Can you turn down those Phentex slippers—which you will almost certainly never wear—without offending the patient who so carefully knitted them for you and many others? Even if you very politely say that your code of ethics prevents you from accepting gifts, it is very likely that your patient will not understand: “It’s no big deal, it’s just a pair of slippers!” Indeed, some patients offer gifts simply as a way of showing their appreciation, without any expectations. Others, to whom we dedicate our selves body and soul, do not even have the consideration to say, “Thank you, Doctor.” Beyond the value of a gift, it is important to consider how it could influence the physician-patient relationship. How will you react the next time your waiting room is bursting and your gift-giver is waiting there with your other patients? And how will you respond when this same individual, usually afflicted with numerous ailments and diseases, comes to you, miraculously healed, and asks for a medical certificate in order to have his or her driver’s licence renewed? Will you remain objective? Will you indicate that the patient does not hear well or has episodes of hypoglycemia, or will you overlook these facts? If you overlook them, you are saying that the Phentex slippers do affect your relationship. This is even truer if the gift is neither modest nor reasonably priced. As family physicians, we must exercise sound judgment. For those of us who would have difficulty turning down “2 tickets, all expenses paid, to see Celine Dion sing in Las Vegas” or “my condo in the Virgin Islands” on the pretext that it’s no big deal (!) and that it would not change a thing (!!), remember that, eventually, the truth will come out and that our professional order is diligent about ensuring compliance with our code of ethics. I invite you to read “Accepting gifts from patients” on page 1259.1 By the way, I have a lovely pair of Phentex slippers for anyone who is looking for stocking stuffers this holiday season.