Accepting Seasonal Gifts from Patients
It’s that time of year again when we need to discuss the elephant in the room, or perhaps more aptly, the gift horse under the tree – patients who give presents to their doctors.
Over the seasonal period, you may be confronted with well-meaning patients and families eager to show their gratitude towards you and your team. It is important that you know how to react when this happens and understand the rules around accepting gifts from patients before you get put into an awkward position.
In this article, we will be discussing the ethics and guidance around accepting gifts from patients.
🤷 What’s the issue?
On the surface, you might not think there is any problem with accepting gifts from your patients. However, it is actually a significant ethical issue that is important to understand and relates to deeply ingrained social rules by which we are subconsciously controlled.
‘Reciprocation’ is a social norm that refers to the expectation that we should somehow return the favour when someone does something for us. This norm is deeply ingrained in many cultures and can influence our behaviour in both conscious and unconscious ways.
The most common example of reciprocation is the exchange of gifts, but it can also relate to the exchange of favours. When someone gives us a gift, we often feel a sense of obligation to return the favour by giving them a gift in return. This urge can be especially strong when the gift is valuable or personal, as we may feel that we need to match the level of thought and effort that the other person put into their gift. Similarly, when someone does us a favour, particularly an unsolicited favour, we may feel highly obliged to reciprocate.
This subconscious, unspoken social dialogue can lead to feelings of satisfaction and camaraderie when done correctly and can lead to feelings of resentment and dislike if done wrong.
For example, imagine you pass your neighbour in the street. You say hello, and they say hello back, and then you continue on your merry way. You may feel acknowledged, satisfied, and closer to your neighbour as a result. Now imagine that your neighbour blanks you as you walk past and say hello, even though you know they saw and heard you. You might feel offended, rejected, self-critical and dislike towards your neighbour.
Reciprocation, when not handled appropriately, can create feelings of resentment or discomfort, as people may feel pressured to return favours that they are unable or unwilling to give.
When a patient gives a doctor a gift, the doctor may feel obligated to reciprocate by giving preferential treatment. Or, if the doctor does not feel able to reciprocate, they may resent the patient due to this unfulfilled social obligation.
It’s important to note that this is generally all taking place subconsciously, which makes it all the more important to be aware of how it can influence our behaviour and relationships.
🎁 What constitutes a gift?
NHS England says, ‘a gift means any item of cash or goods, or any service provided for personal benefit, free of charge, or at less than its commercial value.’
🤔 What are the rules?
The GMC’s "Good Medical Practice" guidance states:
👉 You must be honest in financial and commercial dealings with patients, employers, insurers and other organisations or individuals.
👉 You must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients.
👉 If you are faced with a conflict of interest, you must be open about the conflict, declaring your interest formally, and you should be prepared to exclude yourself from decision-making.
👉 You must not ask for or accept – from patients, colleagues or others – any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients or commission services for patients. You must not offer these inducements.
NHS England says that you should never ask for a gift. If you are presented with a gift, you should never accept any cash, vouchers, or ‘gifts that may affect, or be seen to affect, your professional judgement.’ Gifts valued at over £50 should be declared by staff and only accepted on behalf of an organisation (i.e. to an organisation’s charitable funds) and not in a personal capacity.
Modest gifts under a value of £50 do not need to be declared, but if you have had multiple gifts from the same source over a 12-month period where the cumulative value exceeds £50 then these should be treated the same as a single gift over £50 value. If you don’t know how much a gift is worth, then NHS England says you should use ‘a common sense approach’ meaning that you should take a reasonable guess.
There may be additional specific policies or guidelines in place within your own organisation, so if you do receive a gift that you think may be appropriate to keep but aren’t sure about, it is best to declare it and let the organisation decide on your behalf.
🙏 How to politely refuse a gift from a patient
Now that you know the ethics around accepting gifts and the rules and guidance in place, you can prepare some key statements to use when you are next confronted with a gift from a patient that may not be appropriate for you to accept.
It is important to handle the situation with tact and sensitivity and recognise the good intentions of the patient.
👉 "Thank you so much for your thoughtful gesture. It is so kind of you to say how much you appreciate the care you have received here and that you are happy with the team. Words of thanks mean so much to us."
Start by thanking them for the gesture and expressing your appreciation for any kind words that they have given you. Focus on your gratitude for the sentiment behind the action of giving the gift. Their expression of thanks and appreciation, not for the gift itself, is what you will be keeping. What you are expressing is that the words mean more than the gift itself - maybe next year they will just bring a card which you will be able to keep as a happy memory (and can be saved in a portfolio and presented at appraisal, by the way) in the long run.
👉 ‘I’m afraid I am not allowed to accept gifts of this value from my patients. I'm flattered that you would consider giving me such a thoughtful gift, but I'm afraid I cannot accept it.’
When refusing a gift, you should state clearly that you cannot and will not accept it, while also being courteous and sensitive of the patient’s feelings. You do not want to make them feel uncomfortable or rejected.
👉 ‘There are strict rules about the kind of gifts that healthcare workers can accept but we always love cards and kind words that we can keep forever. The best gift is knowing that my patients are happy, and that my team and I are providing the best possible care to everyone.’
Reassure the patient that your professional relationship is unchanged and that you remain committed to providing the best possible care to all of your patients. Depersonalising your relationship with the patient (i.e. grouping yourself with your team and referring to all of your patients as a collective) can help them feel reassured that your professional relationship remains unchanged and that you are not rejecting them.
👉 ‘If you really want to show your appreciation with a gift, can I suggest making a donation to a charity or a box of chocolates for the ward staff to share?’
Instead of rejecting the gift, try deflecting it. This can help reduce any possible sense of rejection on behalf of the patient and remove the sense of unmet reciprocity.
🩺 What about gift-giving between colleagues?
Small tokens of gratitude between team members can be a good way to show appreciation for your colleagues. Cards, chocolates, or hot drinks are small, inexpensive, but meaningful gestures between co-workers.
Better yet, consider doing a plaudit or excellence report for your colleague or team. These are the opposite of a datix and are sometimes termed a ‘gratix’. These require a very small amount to write and can be exceptionally rewarding for the recipients. They contribute to a sense of recognition, appreciation, and camaraderie and can be added to a portfolio and kept for the remainder of a career.
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