Is it ethical to receive gifts from patients? To decline gifts?

Case studies

Patient A

“A patient who had been my patient for a short time, gave me a golf pull cart .I had agreed to prescribe a regular, monthly amount of a controlled substance.for his anxiety disorder. We had discussed our mutual affinity for golfing.”

Patient B

“A patient brings me apples every year. Last year, I went to his house after hours to check on him because he had serious symptoms and we came up with a plan that kept him out of the hospital. He was a friend of my family, we attend the same church and his granddaughter and my daughter attended school together. While on my house call, I noticed he had a very nice house. After that, he gave me a $100 dollar gift certificate to a restaurant.”

Patient C

“I get a frequent gift of ethnic food that my patient prepares herself. She has been a patient of mine for a long time.”

Though the lines might seem obvious, let’s review the AMA ethics rules and figure out which patient-provider interaction is crossing the line into unethical behavior.

(See AMA Code of Ethics Code of Medical Ethics Opinion 1.2.8[1])

“Some patients may offer gifts or cash to secure or influence care or to secure preferential treatment. Such gifts can undermine physicians’ obligation to provide services fairly to all patients; accepting them is likely to damage the patient-physician relationship” This probably applies to patient A. Since he has not been a patient long, such a nice gift might be prompted by an impulse of kindness sparked by a conversation about a mutual hobby but doubts about the intention of corrupting the relationship by reducing barriers to getting a controlled substance can’t be countered like a long-standing bond might.

“Be sensitive to the gift’s value relative to the patient’s . . . means. Physicians should decline gifts that are disproportionately or inappropriately large.  Decline a bequest from a patient if the physician has reason to believe accepting the gift would present an emotional or financial hardship to the patient’s family.”

Though I didn’t review Patient B’s tax return, from knowing him on a personal level and noticing his house,  I am pretty sure a basket of fruit or a $100 gift certificate is not going to cause him hardship.

“ Some patients may offer gifts or cash to secure or influence care or to secure preferential treatment.” Patient C’s recurring gifts might be construed as expecting preferential treatment or at least  to minimize barriers like other patients might run into yet as long as the provider adheres to the same constraints other patients have I think this is a reasonable gift acceptance.In other words, the provider should not “ allow the gift or offer of a gift to influence the patient’s medical care.” It is not cash, not extravagant and the patient is a long-standing customer so one has something to base an assumption that  it is a gesture of appreciation and affection.  I think the duration of the relationship is a relevant factor though I can’t find a part of the ethics code to support that. “Some gifts are offered as an expression of gratitude or a reflection of the patient’s cultural tradition. Accepting gifts offered for these reasons can enhance the patient-physician relationship.” So, not accepting this offering is probably the less ethical thing to do.