Can you accept gifts from patients this holiday season?

During the holiday season, cheer abounds. The infectious nature of merriment often spreads to your patients, who value the physician-patient relationship. When (small) gifts reflect cultural traditions or express gratitude, accepting them can enhance the professional bond. Some gifts, however, are inappropriate to accept.

The ethics behind accepting gifts from patients is covered in the AMA’s Code of Medical Ethics. Let’s consider several scenarios in which accepting gifts is a bad idea.

Scenario 1: Above and beyond

Ms. A has been Dr. X’s patient for several years. Dr. X is an internist who has diligently managed Ms. A’s conditions, including hypertension and high cholesterol levels. He has successfully advised her on lifestyle changes such as diet and weight loss. Ms. A highly respects Dr. X and values the care that he provides.

One Christmas, Ms. A decides to do something extra special to show how much she appreciates Dr. X. She presents him with a very expensive watch. Because Dr. X has learned to carefully consider any gift before it is given to him by a patient, he tells Ms. A that he must unwrap the gift in her presence. When he does, he is shocked at the gift, which, based on the brand, he immediately values at more than a thousand dollars. 

Ethical considerations. The AMA advises that physicians should be sensitive to the monetary value of the gift before accepting it. If the gift is too expensive, then the physician should politely demur and explain that it is inadvisable to accept the gift. One good measure of whether a gift is inappropriately large or expensive is whether the physician would be uncomfortable or embarrassed if colleagues were apprised of the gift. 

Scenario 2: Attempted quid pro quo

Mr. B has just started seeing Dr. Y. It is around the holidays and Mr. B brings in a lovely gift basket. On the surface, the gift doesn’t seem too expensive to accept. But, shortly after presenting the gift basket, Mr. B asks Dr. Y for a “sick note” to skip work the next day. Mr. B is not acutely ill.

Ethical considerations. Dr. Y should refuse the gift on the grounds that gifts shouldn’t be attached to patient expectations, per the AMA. Patients should all be treated in a fair manner, and accepting a gift basket in trade for a medical excuse is unethical and undermines the dynamics of the physician-patient relationship. 

Scenario 3: Psychological red flags

Tony is a young man who was recently treated in the emergency department after a physical altercation with a neighbor. He has recently been seeing a psychiatrist for treatment of a serious mental health condition. Dr. Z has been Tony’s family practice physician for the past year. For Christmas, Tony presents Dr. Z with brass knuckles, which are a type of weapon. 

Ethical considerations. According to the AMA, some gifts can reflect psychological issues faced by the patient. In this case, in addition to returning the gift (weapon), Dr. Z should immediately consult with Tony’s psychiatrist. Of note, Dr. Z originally referred Tony to the psychiatrist for continued care following his ED visit for fighting.

Scenario 4: Financial strain

Mrs. R recently experienced a uterine rupture during labor. Fortunately, she and the baby survived, with successful surgery performed by her obstetrician-gynecologist. That Christmas Mrs. R presents Dr. W with a $250 gift card to a local grocery store. She tells Dr. W that the gift came from the grocery budget for her family that month. Dr. W knows that Mrs. R is of limited financial means.

Ethical considerations. The AMA advises that physicians should not accept gifts that can cause financial hardship to the patient. In this case, accepting the gift card may mean that there is not enough money left for Mrs. R to feed her family. 

Bottom line

Accepting gifts from patients is a complicated matter that requires careful consideration by the physician. Boundaries and limits must be set. One alternative to accepting gifts is to encourage your patients to make charitable contributions instead. These charitable donations could be small and within the patient’s means.

Finally, there are some guidelines for doctors who are considering giving gifts, too. Read more about that here.