Ethical dilemma: Accepting a monetary gift from a patient may undermine patient-provider trust, according to a new study

When physicians accept donations from patients, they’re not just raising money—they’re sparking ethical debate. In a new report published this Monday, the American College of Physicians (ACP) warns against the ethical risks of “grateful patient fundraising,” and encourages physicians to avoid the practice.^[]

Omar T. Atiq, MD, FACP, President of the ACP, says that grateful patient funding goes against the foundations of an ethical healthcare system, which is built upon trust. 

He adds that the report is especially timely, given the high percentage of physician practices that are owned by institutions. Numbers of institution-owned practices have greatly increased over the last 30 years, he adds, and now nearly 70% of US physicians are employed by hospital systems and corporate entities, he says.^[]

The ACP report outlines three types of ethical dilemmas provoked by grateful patient fundraising. These include grateful patient fundraising’s potential to break patient-provider trust, threaten patient privacy and confidentiality, and influence physicians’ priorities in their practice. 

In terms of how grateful patient fundraising can impact patient-provider trust, the report says that this kind of solicitation may cause the patient to feel that their provider values them as a source of money rather than as an individual. In one study referenced in the report, researchers suggest that grateful fundraising may cause patients to “worry that their doctor sees them as a purse rather than a person.”^[]

Whether or not physicians view patients like this is unclear—and the answers may vary among physicians. Regardless of whether or not this occurs, it is important for physicians to recognize the power balance between them and their patients and to act with their patients’ best interests in mind, says Dr. Atiq.

“We want to make sure that physicians are cognizant of this potential,” Dr. Atiq says. “It's not that we have seen that happen, but all of us together believe that [this] could be a possibility, especially for physicians who are blindsided.”

He adds that “the physician-patient relationship is one of trust,” which should be prioritized.

Patient role in grateful patient fundraising

This task does not fall to healthcare workers alone. Sometimes, patients may feel inclined to give large amounts of money as a gift to a provider they are fond of. The ACP report suggests that gifts to physicians should be and only “token[s] of appreciation”; it further suggests that physicians should encourage patients to donate to the larger institution.

This year, an Australian physician was met with much more than a “token” from a deceased patient, who had left him $24 million dollars in their will. The lavish gift caused an uproar from the original beneficiaries of the will, who took the physician to court and claimed that he had abused his doctor-patient relationship for financial gain. The original beneficiaries' initial case was unsuccessful, but the physician was taken to court again and charged with medical malpractice. 

Using fundraising for good

While the paper warns against direct solicitation of patients’ funds, it does not condemn fundraising writ large. In fact, fundraising can be an essential means of wealth for many practices.

“If a physician utilizes patient information for anything other than the care of that patient, which includes fundraising, that's problematic,” Dr. Atiq says. “On the other hand, healthcare systems all throughout history have depended on philanthropy.”

To fundraise ethically, Dr. Atiq recommends that physicians take a broader stance, such as encouraging the public to make donations to the larger institution that they represent and, “making the case that those funds are needed for better patient care overall and for those who are unable to afford it.”

Dr. Atiq says everyone can benefit from the report—patients, physicians, and institutional leaders alike. He hopes that it will be well-received and does not anticipate backlash. 

“Physicians and the healthcare system as a whole will be receptive to the report. All of us are patients at some point [in] time, so trust in physicians can be viewed as a universal issue,” he adds. 

“It is intended to encourage everybody to remember the interest of the patient. We hope that this would reaffirm and rekindle that feeling that all of us as physicians, as healthcare professionals,” Dr. Atiq says.

“I am a physician today; I could be a patient tomorrow,” Dr. Atiq says. “We want to make sure that all of us are comfortable, that when we become patients and go see a physician, the objective and the underlying ethos would be our best interest.”