Gifting Season Can Present Ethical Dilemma for Physicians

On the other hand, Dr. Helft, an oncologist, recalls accepting a handcrafted pen a decade ago from a patient who had completed treatment for esophageal cancer. The patient had made the pen by turning wood on a lathe in his own workshop. Rejecting something special that someone took the time and effort to create could be perceived as a real snub, said Dr. Helft, who stores the pen as a keepsake in his desk at work. “Obviously, patients are free to make gestures or give gifts as they see fit or as their feelings drive them to do. In general, it’s okay to accept gifts when they amount to tokens. The problem, of course, is that it raises the question of whether these gifts could be construed as some sort of quid pro quo.”

At The Children’s Hospital of Philadelphia, where Dr. Handler works as a pediatric otolaryngologist, hospital policy states that any gift of more than nominal value must be turned down. While that actual value is left up to the physician’s discretion, “if someone made a craft—a little handmade thing—I imagine it would be acceptable,” Dr. Handler said. And when it comes to baked goods, he sincerely thanks the giver and responds, “I’m accepting this for my team.” He then shares it with his office or hospital staff. Patients “realize that whatever I do, I don’t do it on my own,” he said.

“This is a professional relationship, and that role has certain parameters or limitations.”

—Micah Hester, PhD, clinical ethicist in Little Rock, Ark.

For Daniel Samadi, MD, a pediatric otolaryngologist in private practice in Hackensack, N.J., gifts flowed in this fall from patients congratulating him on the birth of his son. A steady stream of presents also followed his daughter’s birth two years earlier. To acknowledge Dr. Samadi’s dedication, the families of young patients brought in or sent baby clothes, toys, flowers, trays of cookies, cupcakes and chocolate.

Still, Dr. Samadi maintains that he doesn’t accept any gifts personally, and he tells patients and families that doing so would violate medical ethics. If they insist, he opens the presents in front of them. “I thank them profusely,” he said, while asking for permission to offer the items to his staff members, many of whom also have young children or nieces and nephews. This usually resolves the issue.

“I don’t want the patient to feel like I’m dismissing what they’re trying to do,” Dr. Samadi said. “But at the same time, I want to appreciate the staff for their support and care, and for really being the backbone of my practice.”