A 58-year-old man comes to the office for follow-up. The patient is under the physician's care for management of diabetes and hypertension and was recently hospitalized for a diabetic foot infection. In the hospital, he received antibiotic therapy and his insulin regimen was adjusted to optimize glycemic control. The patient has been well since hospital discharge and is compliant with his medications. He has returned to work full-time but worries about his health and hopes the physician might be able to see him for a same-day appointment should he experience any discomfort. Physical examination is unremarkable. Toward the end of the visit, the patient presents the physician with a watch as a gift, saying, "It wasn't expensive; it is just a small token of my appreciation for your excellent care." Which of the following is the most appropriate course of action regarding the gift?

Question

A 58-year-old man comes to the office for follow-up.  The patient is under the physician's care for management of diabetes and hypertension and was recently hospitalized for a diabetic foot infection.  In the hospital, he received antibiotic therapy and his insulin regimen was adjusted to optimize glycemic control.  The patient has been well since hospital discharge and is compliant with his medications.  He has returned to work full-time but worries about his health and hopes the physician might be able to see him for a same-day appointment should he experience any discomfort.  Physical examination is unremarkable.  Toward the end of the visit, the patient presents the physician with a watch as a gift, saying, "It wasn't expensive; it is just a small token of my appreciation for your excellent care."  Which of the following is the most appropriate course of action regarding the gift?

Quizplus · Accepted Answer

Explanation: Accepting or declining gifts can raise complex issues in the physician-patient relationship. In the absence of definitive guidelines, some physicians prefer to have a no-gift policy. Others argue that accepting gifts in some circumstances can strengthen the physician-patient relationship, whereas declining the gift can be harmful. Despite these differences of opinion, there is general consensus that gifts accompanied by expectation of preferential treatment, or that are extravagant, excessively valuable, or intimate, should be declined. Acceptance of such gifts is ethically problematic as it may influence or appear to influence the physician's professional judgment. In this case, there is concern that the patient's gift is associated with expectations that he will receive preferential treatment in the form of special and/or immediate access to the physician. If a physician feels uncertain or cannot assess the motivation behind the gift, it should be declined. Ethically, the most appropriate response is to express appreciation for the gesture but decline the gift and assure the patient that he will continue to receive the same standard of care. (Choice A) It is difficult to know the actual value of the gift. Regardless, the possibility that the patient expects preferential treatment makes accepting the gift ethically problematic. (Choice B) Although the gift was given in appreciation, there is also concern that the patient may now expect preferential treatment. (Choice D) Telling the patient that his gift is inappropriate is judgmental and could harm the physician-patient relationship. It would be better to decline the gift but express appreciation for the gesture and assure him that he will continue to receive excellent care. (Choice E) Accepting small gifts given as expressions of gratitude and without expectation of special treatment is not considered unethical. Educational objective: It is unethical for physicians to accept gifts motivated by expectation of preferential treatment. These gifts should be declined after expressing appreciation to the patient for the gesture. Gifts of small value that are expressions of gratitude are acceptable. References: The price of a gift: an approach to receiving gifts from patients in psychiatric practice. (http://www.ncbi.nlm.nih.gov/pubmed/17454174) Accepting gifts from patients. (http://www.ncbi.nlm.nih.gov/pubmed/24336530)

A 58-Year-Old Man Comes to the Office for Follow-Up