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Should we beware of the patient bearing gifts?

Whilst I was observing a doctor in an oncology clinic, the doctor mentioned to me a gift she had received the previous week from a patient after giving her the wonderful news that she was cured of her lung cancer. This gift was a pair of concert tickets, which clearly cost a lot of money, and made me think about the ethical issues of, and the regulations behind, receiving a gift from a patient. However, thieves and con-artists don’t give up easy, so here are the tactics you can expect them to use. You can expect them to represent themselves using domain names that sound like government agencies. Names such as Obama Modification, or Obama Housing Plan, and similar names. They will buy.org domains to present themselves as non-profit agencies. For instance, there are bankruptcy Long Island Personal Injury Law Firm, family law and divorce lawyers, tax lawyers, etc. There is no area of practice known as loan modification. Many attorneys can provide help with a loan modification. But, it’s important to understand, that the only party that can modify your mortgage is the lender. Well you can read some tips here for mortgage investment.  The attorney can only help facilitate it. It’s fine, even a good idea to retain an experienced attorney to help you when you are faced with a financial hardship and the possibility of losing your home.  A law firm is a law firm and has no need to qualify itself as back, based, or driven. If you are facing these issues, most law firms offer free consultations to discuss your case. Take that opportunity to meet with an attorney and find out how they can help you. It will cost you nothing and may save you not just thousands of dollars, but very likely will save your home as well. David Miller is a freelance writer and marketing consultant. He has written extensively about bankruptcy, debt settlement, debt consolidation, credit and credit cards, collection agency abuse, consumer law, credit card defense, FDCPA guidelines and complaints, loan modification scams, and foreclosure.

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 It is human nature to show gratitude for a deed done. This is why after a doctor has treated a patient they are sometimes presented with a gift from the patient or a relative. This becomes particularly apparent at Christmas time with long-term patients whom doctors see on a regular basis. This gift is usually simply a token of their gratitude towards the doctor and is meant in good will. Of course, the gift may not be given in gratitude, but meant as a bribe or used as a way of manipulating the physician into a particular treatment decision. Thus, receiving and accepting this gift raises a few ethical dilemmas. The acceptance of the gift can be suggestive of bribery and favouritism when it comes to treating the patient on a subsequent occasion or even influencing the doctor’s treatment decision if received part way through treatment. The GMC guidance in ‘Good Medical Practice’ (GMC, 2013) states in their ‘Honesty in Financial Dealings section’:

“You must not ask for or accept – from patients, colleagues or others – any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients or commission services for patients. You must not offer such inducements.”

Under the Bribery Act (2010), bribery is defined as “inducement for an action which is illegal, unethical or a breach of trust” with inducements being in the form of “gifts, loans, fees, rewards or other privileges”. Thus clearly this is a relevant piece of legislation to the ethics of receiving a gift from a patient.

Gifts can often range from tickets to a concert or show, money, high street shop vouchers, wine, or just a box of chocolates. The value of the gift, in terms of monetary value, is more important than what the gift actually is. Where these gifts are easy to share, for example a box of chocolates, then most healthcare professionals would place these in the staffroom or nurses’ office for everybody to share. The current General Medical Services (GMS) contract states that any gift worth over £100 must be declared and the details must be kept in a register at the hospital or surgery (MPS, 2013). Of note, individual hospital trusts will have their own rules, so it is worth finding out what your local policy is. For example, one hospital trust clearly states that while small gifts e.g. chocolates are ok up to a value of £25, larger gifts e.g. wine or food hampers are not and should be refused and entered onto the hospitals gift register.

If local rules are not followed, not only would it constitute a breach of employment with the ultimate sanction being dismissal, the doctor who received the gift may even be accountable on the Bribery Act charge, which has the maximum penalty of 10 years in prison and an unlimited fine. The advice given is that if you do accept a gift, you must declare it, be able to prove that it did not influence your treatment decisions regarding that patient and to make sure that the patient is aware of the implications.

The size of the gift is also important when considering how substantial it is and whether the patient can afford this gift within their means. If you believe this gift is too extravagant for the patient to afford then the best thing to do would be to politely refuse it. The refusing of the gift is one of the main ethical issues, where the act of refusal may offend the person giving the gift and even disrupt the doctor-patient relationship which has clearly reached a certain level of respect and kindness. An excellent and important example of this can be learnt from the high profile case of psychiatrist Dr Peter Rowan who accepted monetary gifts of £50,000, £100,000 and a £1.2 million beneficiary from a woman under his care in London (MDDUS, 2010). When he tried to refuse these gifts she became angry and he felt obligated to take them. Due to the large amount of money, he made sure this was within her financial means by consulting her solicitor. Dr Peter Rowan has since been struck off due to the unclear reason why his patient left him £1.2 million in her will.

The concert tickets gift received by the doctor in the oncology clinic mentioned above clearly cost more than £100 and thus had to be declared. The doctor, not wanting to offend the patient, accepted the tickets and feeling it was not right to accept the tickets for her own use, organised a raffle for everybody in the oncology department to win the tickets. This, to me, seems like an appropriate and perfectly acceptable decision, which solves the ethical dilemmas of accepting the gift and not offending the patient, but not being accountable for using the gift as a bribe or to influence patient treatment by raffling the tickets for the whole department.

Kathryn Miller
3rd year Medical Student, KCL, London, UK
@Kathryn4365058

5 replies
  1. Matthew Bultitude
    Matthew Bultitude says:

    Great blog Kathryn. Actually a very important issue that I’m sure many people are unaware of. I didn’t know my hospital had a policy on this till I read this. Fortunately no one has offered me a £1.2 million gift but it can be difficult to know what to do with bottles of wine etc given as gifts. We often have charity raffles arranged by some of our volunteers which seems a happy solution to donate to that.

    What is the policy in other countries ? There must be regulations as well ?

  2. Mr Conrad Bishop
    Mr Conrad Bishop says:

    Very interesting blog about a very grey area. It’s very common to be given a bottle of something by patients at this time of year and I personally have no problem by this. I would be very concerned however if a patient came bearing gifts BEFORE their surgery. That would have alarm bells ringing…

  3. Ben challacombe
    Ben challacombe says:

    Kathryn
    Excellent point for discussion and extremely relevant at this time of year. I usually get a few individual bottles of wine which I accept but for larger gifts the raffle idea seems very sensible.
    I would doubt that any of my colleagues receiving larger gifts have ever declared them but they probably have a record of who gave what and when, and I feel they are unlikely to be manipulated.
    So far I have not met a patient who was overtly trying to manipulate with gifts. When I received some supermarket tokens I shared them out to other members of the team.
    Has anyone ever declared these or had a huge gift I wonder?
    Ben

  4. Prokar Dasgupta
    Prokar Dasgupta says:

    My granddad was an old fashioned doctor who inspired me. Often many of his patients were not wealthy enough to pay him his fees. Insted they would pay him in kind. Vegetables, fruits, whatever they could find. It was affection and respect. Important aspects of the “noble profession”. As long as we thank our patients (I write to them) and declare what we have received, I do not see a major problem. Incidentally, a patient from our local bakery sends me a massive cake every XMAS. All the staff in my department share it along with steaming hot cups of tea on a cold day in December. This has been an annual event for the last 10 years. Pray, where is the problem?

  5. Declan Murphy
    Declan Murphy says:

    I may be a victim of stereotyping but I do seem to get a lot of single malt whiskey. Maybe I look like a man who enjoys the odd dram! I have accumulated quiet a stash of it and would be happy to trade for some quality pinot noir if anyone is interested!

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