×
Home Current Archive Editorial board
News Contact
Review paper

Very first patient gift in a general practitioner’s career and the impact of this event on physician-patient relationship

By
Vesna Kos Orcid logo
Vesna Kos
Contact Vesna Kos

Department of Family Medicine, School of Medicine, University of Zagreb , Zagreb , Croatia

Abstract

Aim
To describe experiences, feelings and reactions of general practitioners (GPs) to the very first patient gift in the career, considering the impact on physician-patient relation (PPR).
Methods
A representative sample of the Croatian GPs (N=265) filled in a supervised paper-based, researcher-led questionnaire. The response rate was 95.7%. Three independent analysts coded and analysed respondents' descriptions. The results were analysed using the descriptive statistics, χ²-test, and φ-coefficient of correlation.
Results
The GPs received the very first patient's gift (FG) already as students (2.6%), during internship (41.5%), and at the latest after being a doctor for one year. After 2-42 years of practice, 95.1% of GPs described their FGs. Typical gifts were coffee and/or sweets (66%). Dominant feeling of GPs on receiving the FG was discomfort (33%); only 22% felt good; just 26% reacted with composure. The outcome regarding the physician-patient relationship (PPR) ranged from the debacle (9%), through mutual discomfort (13%) or a routine reaction (38%), to smiles and mutual pleasure (40%). In 18% they tried to behave properly, considering the patient's best interest, despite their own discomfort. In 29% of cases, the patient took the role of teacher, supporting the young physician. The PPR was not improved in 3/5 of cases where the FG was described. Conclusion
Receiving the FG is an impressive and deeply touching event, remembered many years afterwards. Without prior instructions, Croatian GPs mostly reacted in a confused manner. The missed opportunity of improving PPR in 60%, and patients' help instead of teachers' suggest the need for education.

References

1
Willingham B, Boyle M. Not a neutral event’’: clinical psychologists’ experiences of gifts in therapeutic relationships. Psychol Psychother 2011:170–83.
2
Anderson J. Is it better to give, receive, or decline? The ethics of accepting gifts from patients. JAAPA 2011:59–60.
3
Grandhi R, Jm G-K. Gifts: Are there strings attached? J Am Acad Dermatol 2017:587–9.
4
Zinn W. Transference phenomena in medical practice: being whom the patient needs. Ann Intern Med 1990:293–8.
5
Oak J. Accepting vendor gifts. Consider both legal and ethical factors before accepting or giving gifts. Health Exec 2005:32–3.
6
Brown C, Trangsrud H. Factors associated with acceptance and decline of client gift giving. Prof Psychol Res Pr 2008:505–11.
7
Andereck W. Point-counterpoint: should physicians accept gifts from their patients? Yes: If they are given out of beneficence or appreciation. West J Med 2001:76.
8
Gaufberg E. Alarm and altruism: professional boundaries and the medical student. Clinical Teacher 2006:206–9.
9
Drew J, Stoeckle J, Billings J. Tips, status and sacrifice: gift giving in the doctor-patient relationship. Soc Sci Med 1983:399–404.
10
Knox S, Hess S, Williams E, Hill C. Here’s a Little Something for You": How therapists respond to client gifts. J Couns Psychol 2003.
11
Snyder L. American College of Physicians Ethics, Professionalism, and Human Rights Committee. Ann Intern Med 2012:73–104.
12
Smolar A, Eichen A. A developmental approach to gifts in long-term group psychotherapy extending from an anniversary ritual. Int J Group Psychother 2013:77–94.
13
Green C, Polen R, Janoff S, Castleton D, Wisdom J, Vuckovic N, et al. Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results. Psychiatr Rehabil J 2008:9–22.
14
Beach M, Inui T. Relationship-Centered Care Research Network. Relationship-centered care. A constructive reframing. J Gen Intern Med 2006.
15
Grossman J. A welcome gift. A former patient provides the antidote to burnout. Med Econ 2009:47.
16
Knox S, Dubois R, Smith J, Hess S, Hill C. Clients’ experiences giving gifts to therapists. Psychotherapy (Chic) 2009:350–61.
17
Stepurko T, Pavlova M, Gryga I, Groot W. Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. BMC Health Serv Res 2010:273.
18
Street R, Makoul G, Arora N, Epstein R. How does communication heal -Pathways linking clinicianpatient communication to health outcomes. Patient Educ Couns 2009:295–301.
19
Kline N. Gifts from children. J Paediatr Oncol Nurs 2002;(1).
20
Kos V. To Accept or refuse patient’s gift in moneyand how -Case. Report with Review Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2016:127–31.
21
Zur O. Gifts in Psychotherapy & Counseling. Ethics, Cultural and Standard of Care Considerations 2017.
22
Caddell A, Hazelton L. Accepting gifts from patients. Can Fam Physician 2013:1259–60.
23
Abbasi Y, Gadit A. Accepting gifts from patients: how ethical can this be in the local context? J Pak Med Assoc 2008:281–2.
24
Belli P, Gotsadze G, Shahriari H. Out-of-pocket and informal payments in health sector: evidence from Georgia. Health Policy 2004:109–23.
25
Cockcroft A, Andersson N, Paredes-Solís S, Caldwell D, Mitchell S, Milne D, et al. An inter-country comparison of unofficial payments: results of a health sector social audit in the Baltic States. BMC Health Serv Res 2008:15.
26
Gaufberg E. Should physicians accept gifts from patients? Am Fam Physician 2007:437–8.
27
Takayama J. Giving and receiving gifts: one perspective. West J Med 2001:138–9.
28
Cohen N. Informal payments for health care-the phenomenon and its context. Health Econ Policy Law 2012:285–308.
29
Lyckholm L. Should physicians accept gifts from patients? JAMA 1998:1944–6.
30
Capozzi J, Rhodes R. Gifts from patients. J Bone Joint Surg Am 2004:2339–40.
31
Ladouceur R. Should family physicians accept gifts from patients? Can Fam Physician 2013:1254–5.
32
Frey J. McCarthy Beans and Moxie. Fam Med 2017:141–2.
33
Lapid M, Moutier C, Dunn L, Hammond K. Roberts LW. Professionalism and ethics education on relationships and boundaries: psychiatric residents’ training preferences. Acad Psychiatry 2009:461–9.
34
Levene M, Sireling L. Gift giving to hospital doctors-in the mouth of the gift horse. Br Med J 1980:1685.
35
Brendel D, Chu J, Radden J, Leeper H, Pope H, Samson J, et al. The price of a gift: an approach to receiving gifts from patients in psychiatric practice. Harv Rev Psychiatry 2007:43–51.
36
Spence S. Patients bearing gifts: are there strings attached? BMJ 2005:1527–9.
37
Committee On Bioethics, Diekema D, Fallat M, Antommaria A, Holzman I, Katz A, et al. Policy statement--Pediatrician-family-patient relationships: managing the boundaries. Pediatrics 2009:1685–8.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.