Doctor-patient relationship is unique and fragile

Title image: Thanking your doctor: A guide to Giving for Patients and Physicians

The doctor-patient relationship is fragile, and physicians accepting patient gifts can have adverse consequences.

Accepting patient gifts? A giving guide for patients and physicians can help you avoid ethical gray areas.

In the doctor-patient relationship, thanking your doctor shouldn’t be difficult or complicated. But in today’s society, ethical concerns may arise.

The field of pediatric oncology poses many special challenges. Cancer is a grave diagnosis for anyone at any age, but a potentially life-threatening condition in a patient so young, with so much potential, can be overwhelming. So, it’s understandable that parents or family members of pediatric cancer patients often wish to express their gratitude to the physicians who are treating their children or who may have saved their child’s life.

As a physician at St. Jude Children’s Research Hospital specializing in palliative and end-of-life care, I have seen both incredible outpourings of gratitude from patient families toward their doctors and the ethical hazards such gratitude can create. Is giving a gift to your doctor ever appropriate? If you as a physician feel uncomfortable with a gift from a patient or his or her family, what should you do?

There is no absolute correct answer to either of these questions, and these dynamics can trip up providers and patients across any specialty. Much depends on policies established by hospitals and clinics, but here are a few guidelines that may help:

1. What is the nature of the gift?

Homemade brownies or some other small, sincere token can be appreciated without creating a conflicting sense of obligation on the doctor’s part. An extravagant gift, on the other hand, almost always presents a dilemma for a physician. Accepting the gift could create the expectation of favoritism at the expense of other patients; rejecting a gift of significant value risks offending or embarrassing the giver.

2. What is the background of the person offering the gift?

Both culture and experience play a role here. One country’s custom may be another’s no-no. Knowing the culture of the giver might help inform how to respond.

3. Be honest with yourself.

If you’re on the patient side and want to give something to your doctor, can you do so without raising your expectations about the level of attention and care you receive? If you’re a physician, can you accept the gift without then wondering if your obligations have changed?

4. Get a second opinion.

This goes for both patient and physician.

There is nothing inherently wrong with a patient or a patient’s family giving a gift to their doctor. Beyond common sense and good judgment, the doctor will be guided by policies and guidelines established by their employer. If you’re the one wanting to show your appreciation, try to understand why your gift may be turned down. Even better, show your appreciation by giving to a charity in honor of the physician or to a hospital fund that benefits all patients.

Read more about this topic in the Ethics Rounds article, "An Extravagant Gift From a Grateful Patient," from the May issue of Pediatrics.

Akshay Sharma, MD, clinical fellow in the Department of Oncology, contributed to this post.

About the Author

Liza-Marie Johnson

Liza-Marie Johnson, MD, MPH, MSB, is an assistant faculty member of the Oncology Department and consultant to the Bioethics Subcommittee at St. Jude Children’s Research Hospital. View full bio.