Is it compassionate to accept patient gifts?

This week's post is written by Elizabeth Steinmiller (MSN, PMHCNS-BC, Clinical Nurse Specialist in Mental Health), The Children's Hospital of Philadelphia. Children's is one of eight pediatric hospitals named to U.S. News & World Report's Honor Roll of America's "Best Children's Hospitals" for 2010-2011 and a participant in the Schwartz Center Rounds.

Many people express their gratitude during the holiday season by giving a gift to their healthcare providers. Gift exchanges between clinicians and patients and their families can be wonderful interactions or create uncomfortable moments that impact the patient-caregiver relationship.

As noted in an American Medical Association (AMA) article, the motives underlying patient gift-giving can be as innocent as sharing cultural traditions and expressing appreciation or as complicated as the desire to overcome guilt for non-adherence, curry favors from the healthcare provider, or move the relationship from professional to social.

Clinicians can turn to various professional organizations (American Medical Association, American Academy of Pediatrics, National Council of State Boards of Nursing, American Psychological Association) for guidance about patient gift-giving. The AMA, for example, advises that the acceptance of a gift by a care provider, if not handled sensitively and thoughtfully, can negatively impact the professional relationship with the patient and their family members.

Ultimately the best policy may be to discuss the issue with patients before it arises. Several years ago New York Times columnist Tara Parker-Pope wrote a thought-provoking piece about patient gifts. The comments from clinicians were especially informative. Clinicians consistently mentioned that notes of thanks or gratitude were the items they cherished most. By communicating these sentiments to patients in advance, clinicians may be able to avoid the ethical and emotional dilemmas surrounding gifts yet still provide a way for patients to express their gratitude.

How do you communicate with patients about gift-giving?