A 55-year-old man comes to the physician with fatigue, polyuria, and polydipsia. He is morbidly obese and has recently lost about 2.27 kg (5 lb) unintentionally. The patient has blurred vision but no abdominal pain, hematuria, melena, or bruising. Vital signs are within normal limits, and physical examination is unremarkable. The patient's blood glucose is 287 mg/dL, measured by a finger-stick. The patient is diagnosed with type 2 diabetes mellitus, is started on medications, and is greatly relieved to receive a diagnosis. He returns 2 weeks later feeling much better and brings a fruit basket for the physician to express his gratitude. Which of the following is the most appropriate response to this patient's gift?

Question

A 55-year-old man comes to the physician with fatigue, polyuria, and polydipsia.  He is morbidly obese and has recently lost about 2.27 kg (5 lb) unintentionally.  The patient has blurred vision but no abdominal pain, hematuria, melena, or bruising.  Vital signs are within normal limits, and physical examination is unremarkable.  The patient's blood glucose is 287 mg/dL, measured by a finger-stick.  The patient is diagnosed with type 2 diabetes mellitus, is started on medications, and is greatly relieved to receive a diagnosis.  He returns 2 weeks later feeling much better and brings a fruit basket for the physician to express his gratitude.  Which of the following is the most appropriate response to this patient's gift?

Quizplus · Accepted Answer

Explanation: Deciding whether to accept a gift from a patient frequently raises an ethical dilemma. The physician's response should support the best interest of the patient and preserve the physician-patient relationship. Considerations include the gift's cost, the meaning of the gift to the patient, and the patient's probable motivations and expectations for giving the gift. The potential impact on the physician-patient relationship of refusing the gift should also be weighed. Gifts of low monetary value that are given as a token of appreciation or cultural tradition and that are not intended to influence care are generally considered appropriate. In this case, it would be ethical to accept the gift. The patient is grateful for the physician's help, the gift is not excessive, and there is no indication that the gift is motivated by expectation of preferential treatment. Refusing the gift in this situation could be damaging to the physician-patient relationship. (Choices A and B) There are no rules regarding acceptable types of gifts or specific limits on the cost of gifts from patients. (Choice D) It is ethical to accept gifts from patients if the gifts are not excessive and not given to secure preferential treatment or manipulate the physician's behavior. (Choice E) This response is based on the unfounded assumption that the patient's gift giving was motivated by an expectation of special treatment, which does not appear to be the case. Educational objective: Accepting gifts from patients is generally considered appropriate if the gift is not excessive and not intended to influence future care. Decisions to accept or decline gifts from patients should be based on the patient's best interest. References: The price of a gift: an approach to receiving gifts from patients in psychiatric practice. (http://www.ncbi.nlm.nih.gov/pubmed/17454174)

A 55-Year-Old Man Comes to the Physician with Fatigue, Polyuria