Gifts to Physicians

A Brief on the Ethical Implications of Gifts to Physicians
by Travis G. Bias, MS2, Texas College of Osteopathic Medicine

Enjoy being rewarded for a job well done? Would you accept the gift of a nice pen from a patient for successfully reducing his/her blood pressure or relieving his/her chest pain? Would you accept a bottle of wine? Tickets to the Super Bowl? $500 cash?

Gift giving to physicians, by patients or by other professionals in the industry, is a regular occurrence in clinics and other medical institutions throughout the country. The AMA Council on Ethical and Judicial Affairs (CEJA) lays out their opinions on different topics in the AMA’s “Code of Medical Ethics.” “Industry,” defined by opinion E-8.061 (“Gifts to Physicians from Industry”) as “including all proprietary health-related entities that might create a conflict of interest,” generally serves as the greatest source of gifts to physicians. The pharmaceutical industry is a major branch of the industry with which many of us are already familiar, and in a survey recently published in JAMA, only 68.8% of students believed such gifts from pharmaceutical representatives would not affect their practices (Sierles, et al., 2005). According to CEJA, allowing these gifts to affect the practice of medicine is unacceptable. As with gifts from patients, gifts from industry should have no strings attached whatsoever, plus these gifts “should primarily entail a benefit to patients (Opinion E-8.061).”

Patients are another, more personal source of gifts to physicians. In many instances, gifts reflect minor tokens of gratitude, but physicians beware: CEJA states that gifts must be of modest or appropriate value, in relation to the patient’s socioeconomic status and the situation at hand. Cash and gift certificates are intolerable.

Numerous other specifics are laid out within opinion E-8.061. For instance, funding for students and/or residents to attend conferences should be given only for “carefully selected conferences,” and travel expenses for physicians to attend meetings are determined on a situational basis.

CEJA’s position on this topic boils down to two essential themes.  First, the responsibility lies with the physician to determine the appropriateness of the gift’s value, the reason for which it is given, and the situation in which it is given. Secondly, and most importantly, the giving of gifts shall not, in any way, interfere with the proper treatment of patients. While gift giving is an accepted practice, we need to ensure that our unified stance on this issue is translated into action.

In a survey recently published in JAMA, 85.6% of third-year medical students surveyed were unaware of the presence of their institutions’ guidelines regarding interaction between students and industry representatives (Sierles, et al., 2005). Familiarize yourself with your institutions’ guidelines on gift giving, with the AMA’s Principles on Medical Ethics (2001), and with opinion E-8.061, which covers the core of CEJA's stance on this subject. In doing so, you will further your knowledge of situational ethics in this arena and gain the ability to increase the likelihood that your ethical practices will parallel those of your AMA colleagues.

If you are interested in more reading on this subject, check out CEJA’s opinions on PolicyFinder.

References

• Opinion E-8.061. The AMA Council on Ethical and Judicial Affairs. AMA Code of Medical Ethics.  American Medical Association. 22 Sep 2005. www.ama-assn.org.
• Principles of Medical Ethics. The AMA House of Delegates. 17 June 2001. American Medical Association. 22 Sep. 2005. www.ama-assn.org.
• Sierles, Frederick, et al. “Medical Students’ Exposure to and Attitudes About Drug Company Interactions.” The Journal of the American Medical Association. Volume 294, No. 9, September 7, 2005. pp. 1034-1042.