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. p. 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. p. 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. p. 281–2.
5.
Belli P, Gotsadze G, Shahriari H. Out-of-pocket and informal payments in health sector: evidence from Georgia. Health Policy. 2004. p. 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. p. 15.
7.
Gaufberg E. Should physicians accept gifts from patients? Am Fam Physician. 2007. p. 437–8.
8.
Takayama J. Giving and receiving gifts: one perspective. West J Med. 2001. p. 138–9.
9.
Cohen N. Informal payments for health care-the phenomenon and its context. Health Econ Policy Law. 2012. p. 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. p. 127–31.
11.
Capozzi J, Rhodes R. Gifts from patients. J Bone Joint Surg Am. 2004. p. 2339–40.
12.
Ladouceur R. Should family physicians accept gifts from patients? Can Fam Physician. 2013. p. 1254–5.
13.
Frey J. McCarthy Beans and Moxie. Fam Med. 2017. p. 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. p. 461–9.
15.
Levene M, Sireling L. Gift giving to hospital doctors-in the mouth of the gift horse. Br Med J. 1980. p. 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. p. 43–51.
17.
Spence S. Patients bearing gifts: are there strings attached? BMJ. 2005. p. 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. p. 1685–8.
19.
Snyder L. American College of Physicians Ethics, Professionalism, and Human Rights Committee. Ann Intern Med. 2012. p. 73–104.
20.
Anderson J. Is it better to give, receive, or decline? The ethics of accepting gifts from patients. JAAPA. 2011. p. 59–60.
21.
Grandhi R, Jm GK. Gifts: Are there strings attached? J Am Acad Dermatol. 2017. p. 587–9.
22.
Zinn W. Transference phenomena in medical practice: being whom the patient needs. Ann Intern Med. 1990. p. 293–8.
23.
Oak J. Accepting vendor gifts. Consider both legal and ethical factors before accepting or giving gifts. Health Exec. 2005. p. 32–3.
24.
Brown C, Trangsrud H. Factors associated with acceptance and decline of client gift giving. Prof Psychol Res Pr. 2008. p. 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. p. 76.
26.
Gaufberg E. Alarm and altruism: professional boundaries and the medical student. Clinical Teacher. 2006. p. 206–9.
27.
Drew J, Stoeckle J, Billings J. Tips, status and sacrifice: gift giving in the doctor-patient relationship. Soc Sci Med. 1983. p. 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. p. 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. p. 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. p. 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. p. 47.
34.
Knox S, Dubois R, Smith J, Hess S, Hill C. Clients’ experiences giving gifts to therapists. Psychotherapy (Chic). 2009. p. 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. p. 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. p. 295–301.
37.
Kline N. Gifts from children. J Paediatr Oncol Nurs. 2002.
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