‘Tis the Season for Giving – and Receiving

Nearly all doctors will receive at least one gift during their career. Traditional gifts from patients include smaller consumable items such as chocolates, bottles of wine or home-made goods. But how much is too much when it comes to gifts from patients?

Would you accept bottles of wine every couple of months from a patient? Or a $200 gift voucher for a meal? What about an envelope containing $1,000 in cash?

A recent disciplinary hearing¹ involving a GP considered these issues.

Case study

The GP had been seeing an elderly patient every fortnight for more than a decade. The GP acknowledged receiving a couple of bottles of wine every two to three months from the patient. In 2013, the patient delivered a $200 gift voucher for the GP and his wife (also a GP) to enjoy a meal at a local restaurant.

In 2014, the patient offered the GP an envelope which contained $1,000 in cash. The GP denied accepting the money.

Medico-legal issues

At the Professional Standards Committee hearing, the patient's daughter gave evidence that she was aware her father had prepared the cash gift, and she wanted to find out if the GP would take the money. The daughter went with her father to the practice and waited in the reception area while her father consulted the GP. The envelope was in the patient's shirt pocket. She asserted that when the patient came out of the consultation room, the envelope was not there. When she asked her father if the GP had taken the money, he had said, “Yes, and he thanked me profusely!” Although the daughter was concerned about the GP accepting the $1,000, she did not raise the matter at that time or later. 

Based on the evidence at the hearing, the Committee accepted the GP’s evidence that he did not accept the $1,000.

The Committee ultimately made no finding of unsatisfactory professional conduct against the GP.

When is it improper or unethical to receive gifts from patients?

The Committee concluded that the decision to accept a gift was based on self-reflection, discussion with peers and, most importantly, talking to the patient and underscoring that the medical treatment would be just as good whether gifts are given or not.

The receipt of a gift without the doctor reflecting on how the gift might affect the doctor–patient relationship could amount to unethical conduct. It would be improper if the gift giving and receiving were to somehow influence the doctor–patient relationship. It is not enough for a doctor to simply conclude they had not encouraged the gift-giving.

Issues for doctors to consider include:

• motivation in the gift-giving
• the monetary value of the gift
• whether the gift was given during current treatment
• any vulnerability of the patient
• the type of gift – personal or generic
• the frequency of gifts
• attempts by the doctor to encourage, or to discourage and return the gift.

Dr Sara Bird
Executive Manager, Professional Services
MDA National

Reference

1. Professional Standards Committee Inquiry: Dr Richard Grant Wood. Available at: mcnsw.org.au/sites/default/files/decision_-_wood_richard_grant_-_psc_-_18_january.pdf