A few months ago during my inpatient service, I attended to a patient who was homeless, moving from one town to another. She was also an artist but said she had not yet sold any of her paintings. As I finished our visit, she pulled one of her paintings from her bag and said she would like me to have it in appreciation of the care I provided. Caught off guard and not wanting to hurt her feelings, I thanked her and took the painting to my office. But my gut told me this was not the right decision. After discussing the situation with an ethics committee member and doing some research, I decided to go back to the patient to let her know that I was unable to accept her gift and why. Here's how I arrived at that decision.

HOW TO DECIDE

Because there are no clear-cut guidelines about receiving gifts from patients, physicians are often uncertain about how to address the issue. Some argue that accepting gifts from patients can influence a physician's clinical judgment, while others argue that accepting such gifts can enhance the patient-physician relationship.

To decide whether a patient gift is appropriate, it is paramount to first understand the motive behind the gift. Often patients offer gifts to show appreciation for the good care provided or because gift-giving is a cultural or religious practice they enjoy.^1,2 For example, patients will often bring homemade cookies to my clinic during the Christmas season as a token of their thanks. However, some patients offer gifts to their physician as a way to create an unhealthy emotional attachment, meet a personal need, or obtain preferential treatment.^1,3 If physicians suspect improper motives, such gifts should be rejected as they can complicate the doctor-patient relationship and cloud clinical judgment.

Another important issue to consider is the cost or value of the gift. A small gift such as baked goods is probably fine. But an extremely valuable gift should be declined, especially if it is likely to cause a financial hardship for the patient or the patient's family.¹ In my situation, I declined my patient's gift because I felt she could have used the money from selling her painting to secure housing or food.

Often, a helpful test of a gift's appropriateness is whether the physician would be comfortable having colleagues know about the gift.¹ If there's any discomfort, it's probably best to decline the gift.

Rejecting a gift is difficult, especially when you are worried about hurting your patient's feelings and damaging the relationship. To avoid ill feelings, thank the patient for the gift, politely communicate the reasons you cannot accept it, and then assure the patient that this does not change your relationship in any way. If the gift truly had no strings attached, most patients will understand.