Gifting Season Can Present Ethical Dilemma for Physicians

It’s that time of year when tasty treats, handmade crafts and other tokens of appreciation are more likely to infiltrate your practice. Some patients opt to express gratitude in a manner they feel is more pronounced than a verbal or written thank you.

As potential receivers, physicians sometimes find themselves in an awkward position during the winter holidays and on other occasions. While accepting a gift, even with the most innocuous season’s greetings, may compromise the professional code of ethics, refusing it can hurt the giver’s feelings in an irreparable way. Whether you should accept the gift depends, in large part, on its monetary value and whether it can be shared with your staff. A tactful explaination of this rationale helps the giver understand why you’re politely declining.

Obligation

Physicians walk a fine line in acknowledging gifts from patients, said D. Micah Hester, PhD, chief of the medical humanities division in the College of Medicine at the University of Arkansas for Medical Sciences and clinical ethicist at the Arkansas Children’s Hospital in Little Rock. “A typical best practice is to respectfully and kindly refuse any gift. However, there is no question that just like any gift-giving situation, this could cause some tension,” he said. Being sensitive to the possibility that the giver could feel rejected is important. “People sometimes give simply out of generosity of spirit, and to deny somebody the ability to give a gift out of that can seem rude or cold. The challenge physicians have is to be friendly without becoming a friend,” he said.

“You can’t throw any gift back in their face,” said Steven Handler, MD, MBE, a professor of otorhinolaryngology-head and neck surgery at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia. “The danger is in not communicating properly. You need to tell them that you really appreciate their gift and their generosity, but you’re not able to accept it.”

One concern is that a gift may make the physician feel obligated to care for one patient in a different way than for other patients, and the giver may expect different care for giving the gift, said Dr. Handler. “It also may make other patients feel that they may get different care because they didn’t give a gift, or make them feel that they have to give a gift,” he said.