AMA offers guidelines to answer hard questions on patient gifts

Thoughtful consideration is required when deciding whether to accept a present from a patient.

Editorial. Aug. 18, 2003.

A patient's gift to a doctor also can present that physician with an ethical problem. The AMA House of Delegates recently adopted guidelines covering that potentially awkward situation. The new standards are both sensitive to the situation and comprehensive, though they may leave physicians longing for the simplicity of a previous set of gift guidelines -- one that outlined the ethics of accepting gifts from pharmaceutical representatives.

Although those guidelines may not be roundly loved, or perhaps not even roundly followed, they are pretty clear-cut: nominal gifts only, that's all.

The guidelines on patient gifts, written by the AMA Council on Ethical and Judicial Affairs, are much more nuanced. That's not surprising given the intricacies that surround gift giving and receiving in society in general. Whether and how a gift is received -- or rejected -- can have a profound, lasting effect on the interpersonal relationship between the giver and the receiver.

The stakes are even higher when the two involved are in the already delicate dance that is the patient-physician relationship.

The council decided to take on the topic after numerous calls, mostly around the holidays, from physicians and patients seeking guidance on the topic. But it soon realized that gifts are offered up year round by patients who have a variety of illnesses, come from diverse cultural backgrounds and live at varying income levels.