Patients bearing gifts: are there strings attached?

Healthcare Dilemma Towards Gift Giving by Patients

Gift giving is generally well-intentioned and graciously accepted to healthcare professionals but it is also one of the concerns that cause an ethical dilemma in health care. Is the gift giving ethically appropriate? Tangible guidance about how healthcare professionals would respond to gift giving is possibly scarce and non-specific. In cases where there is an absence of hospital policy specifying how to treat patients’ gifts, healthcare professionals may need to reflect several factors when addressing the dilemmas. This factor includes a reflection on the implications of responding to the gifts.

Gratitude in Health Care: A Meta-narrative Review

Research into gratitude as a significant sociological and psychological phenomenon has proliferated in the past two decades. However, there is little consensus on how it should be conceptualized or investigated empirically. We present a meta-narrative review that focuses on gratitude in health care, with an emphasis on research exploring interpersonal experiences in the context of care provision. Six meta-narratives from literatures across the humanities, sciences, and medicine are identified, contextualized, and discussed: gratitude as social capital; gifts; care ethics; benefits of gratitude; gratitude and staff well-being; and gratitude as an indicator of quality of care. Meta-narrative review was a valuable framework for making sense of theoretical antecedents and findings in this developing area of research. We conclude that greater attention needs to be given to what constitutes "evidence" in gratitude research and call for qualitative studies to better understand and shape the role and implications of gratitude in health care.

To Accept or Refuse Patient's Gift in Money? and How? - Case Report with Review

This report describes a (rare) situation when a patient's first gift to a young doctor was in money. This happened in very specific circumstances - in a refugee camp during the War in Croatia. The data are taken from a large study on gifts, conducted on a representative sample of Croatian general practitioners (GPs), N = 265, from 2358 in total. Pro and contra factors are discussed, considering tradition and customs, but also a lack of knowledge of young doctors in handling gifts in general. The intention of this report is primarily educative, with review of (scarce) literature, and recommendations, where the generally accepted rules might have exceptions.

Social Networks and Externalities from Gift Exchange: Evidence from A Field Experiment

This paper asks whether gift exchange generates externalities for people outside of the bilateral relationship between the gift giver and recipient, and whether the nature of this relationship is affected by social networks. We examine this question in the context of a field experiment in urban Chinese hospital outpatient clinics. We first show that when patients give a small gift, doctors reciprocate with better service and a fewer unnecessary prescriptions of antibiotics. We then show that gift giving creates externalities for third parties. If two patients, A and B are perceived as unrelated, B receives worse care when A gives a gift. However, if A identifies B as a friend, then both A and B benefit from A's gift giving. Hence, we show that gift giving can create positive or negative externalities, depending on the giver's social distance to the third party.

Ethical concerns related to grateful patient philanthropy: the physician's perspective

BACKGROUND

Philanthropic contributions to academic medical centers from grateful patients support research, patient care, education, and capital projects. The goal of this study was to identify the ethical concerns associated with philanthropic gifts from grateful patients.

METHODS

A qualitative study design was selected. Investigators conducted in-depth semi-structured interviews with 20 Department of Medicine physicians at Johns Hopkins who were identified by Development Office staff as experienced and successful in this realm-those having relationships with multiple patients who have made philanthropic contributions. Interview transcripts were independently coded by two investigators. Content analysis identified several themes related to ethical concerns.

RESULTS

Eighteen informants (90 %) were Associate Professors or Professors; two (10 %) were females. Four thematic domains emerged related to ethical concerns associated with philanthropy from grateful patients: (i) impact of gift on the doctor-patient relationship; (ii) gift acquisition considered beyond the physician's professional role; (iii) justice and fairness; and (iv) vulnerability of patients. Despite acknowledging at least one of the aforementioned concerns, eleven physician informants (55 %) expressed the view that there were no ethical issues involved with grateful patient philanthropy.

CONCLUSIONS

In this paper, we report that physicians involved in grateful patient philanthropy are aware of, and in some cases troubled by, the ethical concerns related to this activity. Further studies could examine how best to prepare faculty for the challenges that may accompany these gifts so as to help them maintain expected professional and ethical standards when accepting grateful patient philanthropy.

Opening the gift: social inclusion, professional codes and gift-giving in long-term mental healthcare

Deinstitutionalisation has not only made the social inclusion of clients a key objective in long-term mental healthcare, it may also affect the role of the care professional. This article investigates whether the social inclusion objective clashes with other long-standing professional values, specifically when clients give gifts to care professionals. In making a typology of gifts, we compare the literature on gift-giving with professional codes for gifts and relate both to the objective of social inclusion of clients. Our typology draws on an analysis of ethnographic fieldwork carried out in 2007/2008 at a Dutch mental healthcare centre. We identify four types of gifts for professionals in long-term mental healthcare, each relating individually to professional codes and the objective of social inclusion of clients. Only the 'personal gift' directly supports social inclusion, by fostering personal relationships between professionals and clients. Acceptance of this type of gift is advocated only for long-term care professionals. We suggest that professional codes need to consider this typology of gifts, and we advocate promoting reflexivity as a means of accounting for professional behaviour in deinstitutionalised care settings.

A randomized trial to evaluate methodologies for engaging academic physicians in grateful patient fundraising

PURPOSE

Donations from grateful patients can support medical education, research, and clinical programs. This study sought to compare the effectiveness of three approaches to educating physicians about grateful patient fundraising.

METHOD

In 2010, the authors conducted a randomized trial at an academic health center to compare the effectiveness of three educational strategies that encouraged physicians to participate in grateful patient fundraising. The authors randomized physicians into an "e-mail arm," a "lecture arm," and a "coaching arm." All participants received weekly e-mail articles describing philanthropy processes and outcomes. Those in the lecture arm also attended a single, one-hour training session taught by a physician with prior fundraising success, and those in the "coaching arm" received personalized, one-on-one communications with development professionals. The intervention period was three months. The primary outcome was the number of "qualified referrals" (i.e., individuals capable of making a ≥$25,000 gift) whose names participants provided to the development team during the three months of and three months following the intervention; dollars received was the secondary outcome.

RESULTS

Participants in the e-mail arm (n = 14) generated 0 referrals and $0, those in the lecture arm (n = 18) generated three referrals and $0, and those in the coaching arm (n = 19) generated 41 referrals and $219,550 (five gifts). Of the 19 physicians in the coaching arm, 17 (89%) generated at least one qualified referral.

CONCLUSIONS

A process in which development officers give one-on-one coaching to physicians can effectively enhance collaboration on grateful patient philanthropy.

The marketing of pharmaceutical agents: friend or foe?

OBJECTIVE

The aim of this paper is to provide a viewpoint regarding the marketing of pharmaceutical agents to psychiatrists and examine the results of a brief survey of the nature of booths, and gifts they offered, during 2009 RANZCP Congress in Adelaide.

CONCLUSIONS

The pharmaceutical industry is highly organized and scientifically sophisticated. Efforts to influence our prescribing are likely to have a proven scientific base and to be responsive to evidence.

Professional boundaries: the perspective of the third year medical student in negotiating three boundary challenges

BACKGROUND

The negotiation and maintenance of professional boundaries is a central developmental challenge for medical students in clinical training. The purpose of this study is to assess problem solving strategies, decisions made, level of confidence, and language used by beginning third year medical students when faced with professional boundary challenges.

DESCRIPTION

Forty-two students in the first quarter of their third year at Harvard Medical School viewed three brief audiovisual "trigger" tapes, each depicting a medical student faced with a boundary challenge (the offer of a gift, a personal question from a patient, an errand request by a supervisor).

EVALUATION

There was a high degree of agreement and confidence among students about how to negotiate a monetary gift (reject) and how to respond to a patient's "too personal" question (not answer and/or redirect). However, the students were less confident and more divided on the issue of whether or not to run a personal errand for the team at the request of a superior.

CONCLUSION

Our findings have implications for medical professionalism curricula, especially regarding the importance of mentorship and role modeling in medical education. Effective professional boundaries curricula allow the student to problem solve and practice communication skills in boundary challenging situations.