Receiving gifts from patients during the season of giving

Read time: 3 minutes

Guidance to help make sure the gifts you accept are on the “nice list”

With the holiday season fast approaching, physicians may find their patients wishing to show gratitude for their care by giving a gift. While giving a gift is often a harmless show of appreciation, it can run the risk of inappropriately altering the physician-patient relationship, even resulting in a personal boundary violation. It is up to physicians to work within their professional and ethical guidelines, as well as their employer’s policies, to find the right balance.

To accept or decline the gift, that is the question

While some gifts—such as money or those of a personal nature—are never appropriate to accept, it is acceptable to receive gifts from patients within reason. Some physicians and clinics may choose not to allow gifts from patients whatsoever, which is an acceptable policy and removes the source of a potential boundary violation.

A good starting place is to check with your employer, if you have one, whether there is a policy in place for accepting gifts from patients. This could include a blanket policy of not allowing physicians to accept gifts from patients, or a price limit on the value of gifts to maintain appropriateness. If you are a contractor or own your medical clinic, this may be a good time of year to consider establishing such policy.

Physicians should consider the value of the gift—declining gifts of significant monetary value—and consider whether accepting the gift has the potential to blur the boundaries of the physician-patient relationship by influencing clinical decision-making or the standard of care. It is important for physicians to be aware of the context in which the gift is being offered and consider if the patient may expect preferential treatment or develop unrealistic expectations for the provision of future care as a result of giving the gift.

An easy test to determine a gift’s appropriateness is whether you would want a colleague to know about the gift you’re being offered. If the answer is “No,” it may be best to politely decline the patient’s offering.

Resources to guide your decision-making

CPSA’s Advice to the Profession document on Boundary Violations: Personal has been updated to include guidance on accepting gifts, outlining questions to consider before accepting a gift and an important reminder of your professional obligation that accepting a gift should never influence the patient’s medical care.

CPSA’s Advice to Albertans on Personal & Sexual Boundary Violations recommends a simple thank you as the best way for patients to express their gratitude, but suggests small items like a card, flowers or homemade baked goods for patients looking for a material way of showing thanks. You may wish to have copies of this Advice to Albertans document available to assist in conversations with patients if you choose to decline gifts.

The Canadian Medical Protective Association recommends having a conversation with your patient if you are offered an expensive or inappropriate gift, or multiple smaller gifts, explaining the inappropriateness of accepting gifts for medical services and forming personal relationships with patients. CMPA also advises documenting these discussions in the patient record.

The BC Medical Journal offers helpful guidance for communicating with patients when declining or accepting gifts:

When declining a gift

• Explain the reason you are declining the gift.
• Emphasize that declining the gift is not equal to rejecting the giver.
• Record gifts offered.

When accepting a gift

• Explain that the acceptance of the gift does not alter your relationship or affect treatment quality.
• Discuss accepted gifts with your colleagues to promote accountability and transparency.
• Record gifts received.

If a physician is unsure of whether to accept a gift, they are encouraged to contact CPSA or the CMPA.

Questions? We’re here to provide support and guidance. Please contact CPSA’s Standards of Practice Advisor Chantelle.Dick@cpsa.ab.ca.