Patients are often grateful for the help they receive from doctors, but what should you do if they offer you a gift? Dr Graham Howarth, Medical South Africa Lead at Medical Protection, talks us through some of the legal and ethical implications.
A member – who is a Urologist – had recently got in touch to ask for advice regarding a gift they had received from a patient. They had successfully treated their patient on two occasions for kidney stones, and as a thank-you, had been presented with a gift that had a value of between R 20 000 – R 25 000.
While it may be reasonable to accept a small token of appreciation, gifts of high financial value raise concerns because of the effect it could have on the relationship between the doctor and their patient. Additionally, it could lead to a perception by others that the patient may be given preferential treatment or reduced fees as a result.
Uncovering the patient’s motivation can help in deciding whether a gift is being given for the right reasons. It may be that they are giving it out of gratitude, but it could also be for another reason, such as trying to gain the doctor’s attention or as an expression of feeling towards the doctor. Understanding the reason why a patient is giving a gift is also important when it comes to deciding whether to keep it or not.
The guidelines
The SAMA guidance on perverse incentives states:
“Improper financial gain or other valuable consideration” means money, or any other form of compensation, payment, reward or benefit which is not legally due or which is given on the understanding, whether express, implied or tacit, that the recipient will engage or refrain from engaging in certain behaviour in a manner which is either:
2.9.1 Illegal; and/or
2.9.2 Contrary to ethical or professional rules; and/or
2.9.3 Which, in the opinion of a the HPCSA, may adversely affect the interests of a patient or group of patients, In order to procure some direct or indirect advantage, benefit, reward or payment for the person offering or giving the said money, compensation, payment, reward or benefit, and “perverse incentive” has the same meaning.
In this situation there would need to be consideration given to both the legal and ethical implications. Declining the gift could actually end up having an adverse and negative effect on the patient’s relationship with the doctor, so this too needs to be taken into account.
If in doubt
Accepting a gift from a patient does not amount to an offence of corruption or improper financial gain because there are no legal implications for accepting the gift. However, in this situation, the value of the gift received can arguably be considered significant and we would therefore caution against accepting it.
If you are unsure or need advice, call Medical Protection now and speak to our experts for further guidance.