Should physicians accept gifts from their patients?

The winter holidays are upon us, and you may be on the receiving end of some holiday cheer from your patients. How do you handle that? Do you gratefully and gracefully accept gifts from your patients, or do you tactfully decline? Do you accept the gifts and then later pass the gifts along to someone else?

Reactions and choices can and do vary from physician to physician.

Christopher Drumm, MD, has already received pound cake, homemade pizzellas, wine, hot peppers and an ornament, and the season isn’t even over yet. But he accepted them somewhat reluctantly.

“Because accepting gifts does impact the doctor-patient dynamic,” says Drumm, a family practice physician with Norristown Family Physicians in Pennsylvania. He doesn’t want to feel pressured to order a test or prescribe a Zithromax Z-Pak for a viral infection, for example.
Meanwhile, Gerard Hevern, MD, a family physician in Allenstown, New Hampshire, happily accepted the offer from a neighbor who’s also one of his patients to use his snowblower to clear his driveway after a recent storm dumped two feet of snow. He also accepts homemade treats and other gifts from his patients and thanks them warmly.

Here are a few things to consider when you’re wondering whether or not to accept gifts from patients:

Find out if your employer has an existing policy. The obvious place to start is with your employer (unless you’re the practice owner yourself). Your employer may have a specific policy that allows or discourages gifts. If not, you can always ask if they have any concerns or parameters if you’re in a position to receive a gift from a patient.

Check with your professional association. If you’re just not sure what to do, and you’d like to get some guidance from a third party, consider your professional association.  Some professional associations or organizations may have guidelines or recommendation that you can consult.
For example, the American Medical Association includes an opinion section on Gifts from Patients in the association’s Code of Medical Ethics. This section does not specifically recommend that physicians accept or decline gifts, but it does advise them to consider a number of complex, interacting factors. The AMA’s policy notes that physicians should never allow a gift or offer of a gift to influence the medical care that they provide to those patients.

Consider how accepting (or refusing) a gift will affect your relationship. If a longtime patient brings you a container of homemade cookies or a bottle of wine, how will accepting that gift affect the relationship that you have forged with them? How would refusing that gift affect your relationship? Consider the possible ramifications that your actions could have. If you feel that your action could potentially hurt your relationship or make it awkward, let that guide you in your decision. If you do decide to decline the gift, take care to communicate your reasons for doing so.

Set a limit. If you’re on your own about deciding, you could consider setting a price limit on the things that you’ll accept. The AMA’s Code of Medical Ethics suggests that physicians be sensitive to the value of a gift in context to both the patient and the physician’s means. “Physicians should decline gifts that are disproportionately large or inappropriately large, or when the physician would be uncomfortable to have colleagues know the gift had been accepted,” the section states.

For Drumm, the limit is $20. He calls it his “nothing over $20 rule.”

“I turned away a check and kindly have encouraged patients to keep the gift cards that they have brought in,” he says. “Anything very expensive or anything that is directly correlated to monetary value, I try not to accept.”

Be wary of gifts that are too personal, too. “Gifts for the office and staff are much more acceptable, but when patients make it too personal, you are opening the door up for trouble,” says Nicholas Jones, MD, a plastic surgeon in private practice in Atlanta.

Keep it all in perspective. A gift can just mean that the patient is happy with their results, says Jones. It can just be their way of saying ‘thanks for doing a great job’ and that’s it.

Hevern suggests keeping it all in perspective. He doesn’t think it’s necessary to worry about receiving small items like a tin of brownies or a bottle of a wine from a patient. “The ethical things that I think we should be worried about are the big-ticket items,” says Hevern, naming issues like patients not getting access to the care they need or receiving denials for payment for medical care from their insurance companies.