“Pick one.. it’s Yours”: Patient Gifts to Their Doctors

When I was an intern at Philadelphia General Hospital, my introduction to the hospital was on the general medical ward. This particular ward was where the firemen and policemen went when they were sick and also the politicians of the city. I remember that one of the first patients I was responsible for was a politician. I came to the bedside to perform the patient’s first history and physical in the hospital. I remember, I was greeted with a smile as I approached and then the patient raised his arm. On his wrist were several expensive looking watches. His words to me: “Pick one.. it’s yours.” Well, I didn’t. I felt he was trying to “buy” my personal attention and service before I even started. (Remember, I said he was a politician!) I politely refused his offer and explained that a watch wasn’t necessary. It was my responsibility to provide care to all hospital patients and I would be satisfied to take care of him without a watch. After a bit of further urging, he finally gave up and I did my task without further event.

This episode in my medical experience has been long remembered (40 some years) but also brings up the ethical issue of whether physicians should ever accept gifts from patients. If so, under what circumstances and what kind of gifts? I think it is improper to accept a gift before the act of attending to the medical needs of the patient as in the my intern experience. But what about a gracious gift representing thanks and appreciation for my services after they have been completed? Certainly, it would be inconsiderate of the feelings of the patient to refuse. Would a gold watch be acceptable or should it be a home-made fruit cake? Where does one draw the line? How about a monetary “tip”? I never had that! But if this was offered to me, should I accept that like my barber does? If so, how much of a tip is acceptable? I realize that his issue of a patient’s gift is not the most important issue in medical practice but it does represent ethical concerns: Avoiding acts which may be seen as or indeed are conflicts of interest in the practice of a just form of medicine for all patients could also be paternalistically ignoring the emotional needs of the treated patient to relate to the physician. Before I go any further, I welcome the views of my visitors including physicians. ..Maurice.