‘Twas just the season to be gifting, but there are rules to be followed when a doctor gets a gift from a patient. You are a fiduciary for your patients, bound to only act for their good, and a gift can skew that. On the other hand, the emotional rigors of medical care can form a bond that payment for services alone does not address, and a gift can strengthen the relationship with your patient.

AMA Opinion 10.017 (Gift from Patients) acknowledges that gifts from patients can be genuine expressions of appreciation or part of the patient’s culture but cautions doctors to consider the value of the gift relative to both parties’ means and to ensure that a gift does not influence care. State laws parallel this.

A patient may be able to easily afford what they are being “encouraged” to give in an exploitative situation. The essential point that will apply in all gift scenarios is that the gift must be given freely by a competent patient without overweening by the doctor upon whom they are dependent.

The flip side of exploitation by the doctor is manipulation by the patient. The AMA Opinion holds that “Some patients may attempt to influence care or to secure preferential treatment through the offering of gifts or cash. Acceptance of such gifts is likely to damage the integrity of the patient– physician relationship. Physicians should make clear that gifts given to secure preferential treatment compromise their obligation to provide services in a fair manner.”

The motive for the gift must, therefore, be actual generosity. A quid pro quo for future care or to influence the doctor’s medical decision making is an inherently unacceptable gift, even if the gift is not of a high value.

Gifts as the result of fundraising should never be based on the doctor then delivering selective care. You should also be alert for the pitfalls regarding gifts as charitable donations. A donation in your name to a charity that funds cleft repair procedures made by the parents of the child whose cleft palate you repaired is fully permissible, but the one in your name to a charity that supports liver disease research from parents who want you to accelerate their child’s access to a transplant would not be.

The next step, even when the patient’s purpose is pure personal gratitude, is the gift’s value. As per the AMA Opinion, “No fixed value determines the appropriateness or inappropriateness of a gift from a patient; however, the gift’s value relative to the patient’s or the physician’s means should not be disproportionately or inappropriately large. One criterion is whether the physician would be comfortable if acceptance of the gift were known to colleagues or the public.”

Of course, in every setting, the doctor must be aware of any limitations that their hospital or group has placed on accepting gifts.

This article was written by Dr. Medlaw, a physician and medical malpractice attorney.