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.
Lyckholm L. Should physicians accept gifts from patients? JAMA. 1998;1944–6.
2.
Zur O. Gifts in Psychotherapy & Counseling. Ethics, Cultural and Standard of Care Considerations. 2017;
3.
Caddell A, Hazelton L. Accepting gifts from patients. Can Fam Physician. 2013;1259–60.
4.
Abbasi Y, Gadit A. Accepting gifts from patients: how ethical can this be in the local context? J Pak Med Assoc. 2008;281–2.
5.
Belli P, Gotsadze G, Shahriari H. Out-of-pocket and informal payments in health sector: evidence from Georgia. Health Policy. 2004;109–23.
6.
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.
7.
Gaufberg E. Should physicians accept gifts from patients? Am Fam Physician. 2007;437–8.
8.
Takayama J. Giving and receiving gifts: one perspective. West J Med. 2001;138–9.
9.
Cohen N. Informal payments for health care-the phenomenon and its context. Health Econ Policy Law. 2012;285–308.
10.
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.
11.
Capozzi J, Rhodes R. Gifts from patients. J Bone Joint Surg Am. 2004;2339–40.
12.
Ladouceur R. Should family physicians accept gifts from patients? Can Fam Physician. 2013;1254–5.
13.
Frey J. McCarthy Beans and Moxie. Fam Med. 2017;141–2.
14.
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.
15.
Levene M, Sireling L. Gift giving to hospital doctors-in the mouth of the gift horse. Br Med J. 1980;1685.
16.
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.
17.
Spence S. Patients bearing gifts: are there strings attached? BMJ. 2005;1527–9.
18.
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.
19.
Snyder L. American College of Physicians Ethics, Professionalism, and Human Rights Committee. Ann Intern Med. 2012;73–104.
20.
Anderson J. Is it better to give, receive, or decline? The ethics of accepting gifts from patients. JAAPA. 2011;59–60.
21.
Grandhi R, Jm GK. Gifts: Are there strings attached? J Am Acad Dermatol. 2017;587–9.
22.
Zinn W. Transference phenomena in medical practice: being whom the patient needs. Ann Intern Med. 1990;293–8.
23.
Oak J. Accepting vendor gifts. Consider both legal and ethical factors before accepting or giving gifts. Health Exec. 2005;32–3.
24.
Brown C, Trangsrud H. Factors associated with acceptance and decline of client gift giving. Prof Psychol Res Pr. 2008;505–11.
25.
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.
26.
Gaufberg E. Alarm and altruism: professional boundaries and the medical student. Clinical Teacher. 2006;206–9.
27.
Drew J, Stoeckle J, Billings J. Tips, status and sacrifice: gift giving in the doctor-patient relationship. Soc Sci Med. 1983;399–404.
28.
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;
29.
Willingham B, Boyle M. Not a neutral event’’: clinical psychologists’ experiences of gifts in therapeutic relationships. Psychol Psychother. 2011;170–83.
30.
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.
31.
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.
32.
Beach M, Inui T. Relationship-Centered Care Research Network. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;
33.
Grossman J. A welcome gift. A former patient provides the antidote to burnout. Med Econ. 2009;47.
34.
Knox S, Dubois R, Smith J, Hess S, Hill C. Clients’ experiences giving gifts to therapists. Psychotherapy (Chic). 2009;350–61.
35.
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.
36.
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.
37.
Kline N. Gifts from children. J Paediatr Oncol Nurs. 2002;(1).
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