A 64-year-old man comes to the office for follow-up after a myocardial infarction 6 months ago. The patient's condition has slowly improved, although his clinical course was complicated by a pulmonary embolus and urinary tract infection. During the appointment, the patient gives the physician homemade cookies and a thank-you card containing 4 tickets to a professional basketball game. He says, "I would like to thank you for everything that you've done. Please accept these tickets and enjoy the game." He tells the physician not to worry about the expense, saying, "I get season tickets every year but haven't felt well enough to make it to the games. You have been such a wonderful doctor, and I wanted to give you something to express my gratitude." Which of the following statements is the most appropriate?

Question

A 64-year-old man comes to the office for follow-up after a myocardial infarction 6 months ago.  The patient's condition has slowly improved, although his clinical course was complicated by a pulmonary embolus and urinary tract infection.  During the appointment, the patient gives the physician homemade cookies and a thank-you card containing 4 tickets to a professional basketball game.  He says, "I would like to thank you for everything that you've done.  Please accept these tickets and enjoy the game."  He tells the physician not to worry about the expense, saying, "I get season tickets every year but haven't felt well enough to make it to the games.  You have been such a wonderful doctor, and I wanted to give you something to express my gratitude."  Which of the following statements is the most appropriate?

Quizplus · Accepted Answer

Although gift giving as an expression of gratitude is common in many cultures, accepting gifts from patients can raise complex issues in the physician-patient relationship. From an ethical standpoint, expensive gifts may influence or appear to influence the physician's professional judgment (eg, gift is given or perceived to be given in expectation of preferential treatment and/or impacts the physician's adherence to the standard of care). The consensus and professional standard are that it is unethical to accept gifts of significant monetary value. Some medical offices and hospitals implement a no-gift rule to keep things simple while others implement a dollar-amount rule. Declining a valuable gift should be done with care to protect the patient's feelings and avoid damaging the physician-patient relationship. The physician should acknowledge the patient's generosity and thoughtfulness behind the gift, explain why the gift cannot be accepted (eg, personal, practice, or hospital policy), and assure the patient that this does not in any way change the care provided. Accepting gifts of low monetary value given as a token of appreciation or cultural tradition and that are not intended to influence care is generally considered appropriate (eg, homemade, small gifts that are clearly inexpensive). In this situation, it would be appropriate to accept the cookies and card but decline the expensive tickets with an explanation. (Choices A and C) Accepting low monetary value gifts is not unethical, and the physician should accept the cookies and thank-you card to be sensitive to the patient's feelings. Rejecting this low monetary value, homemade gift could be perceived as rude or hurtful, potentially damaging the physician-patient relationship. (Choice D) It is inappropriate to accept an expensive gift on a conditional basis. (Choice E) It is ethically problematic to accept the expensive tickets, even with the intention of sharing them with the office staff. The patient may feel obligated to provide gifts to the office staff, and the staff may feel compelled to provide preferential treatment to the patient. Educational objective: It is ethically problematic for physicians to accept expensive gifts as they may influence or appear to influence professional judgment. These gifts should be declined after expressing appreciation for the gesture. __________ References: Accepting gifts from patients. (http://www.ncbi.nlm.nih.gov/pubmed/24336530)

A 64-Year-Old Man Comes to the Office for Follow-Up After