Thank you, but I can’t accept it: Navigating patient gift-giving

As people wrap presents for friends and family in this season of gift-giving, many also will dole out tokens of appreciation to co-workers, babysitters, those who deliver the morning newspaper, and, perhaps, to their doctors.

But gifts given in generosity sometimes can put providers in a dilemma, said Dr. Lisa Lehmann, director of the Center for Bioethics at Brigham and Women’s Hospital. Extravagant gifts—and sometimes even small ones—could be seen by doctors, patients, or third parties as attempts at securing special treatment.

“There are potentially problems here,” Lehmann said, “and there’s a way in which we can do this ethically.”

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For starters, she said, doctors should not accept cash of any amount. People who want to donate money should be referred to a foundation or the hospital’s development office.

Small, non-monetary gifts—a box of chocolates or flowers—are ok, she said, but providers should make it clear to patients that they will share them with the rest of the staff, so that the gift becomes one for the practice not the individual.

“It diffuses any of the concerns about the gift changing the patient’s expectations or currying favor with the health care provider,” she said.

Lehmann suggests doctors tactfully decline larger gifts, by citing a no-gift policy. In a newsletter to hospital staff, Lehmann’s center offered these questions doctors should ask themselves in deciding when a gift crosses the line:

Will the patient be offended or feel rejected by my refusal to accept the gift?

Will I feel obliged to treat the patient differently in the future, as a result of having accepted the gift?

Is this patient presenting a small, personal gift as simple gesture of appreciation; or might this gift mask underlying vested interests?

Can I graciously accept the gift on behalf of my team or practice?

Can I express my gratitude and still not accept the gift?

Are there peers or mentors whom I can consult for advice?

The Brigham does not have a hard and fast policy on patient gifts, Lehmann said, though it clearly outlines a no-gift policy from drug and device manufacturers. The issues, of course, are different. The objective of industry representatives is to push doctors to use their products, while gifts from patients often are purely an act of kindness or recognition for caring service. But, Lehmann said, research has shown that doctors’ practices are influenced by industry gifts, so it is important also to ask how they could be swayed by patient gifts.

The American Medical Association offers guidance on the topic, and some hospitals in the state address the issue directly in their employee code of ethics. At Massachusetts General Hospital, staff members may not accept cash gifts from patients or anything valued at more than $200. UMass Memorial Medical Center also has a no-cash policy that allows providers to accept gifts of “a nominal value” and share them with staff.

Gift giving is “part of our social norms around the holidays,” but Lehmann said patients should consider the implications of their gifts, too. Ultimately, ensuring that gifts don’t improperly influence providers is about protecting all patients’ interests, she said.

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