Dr Kathryn Leask
It's nice to feel valued for your work – but is it ever appropriate to accept gifts from patients? Dr Kathryn Leask discusses.
A student working on a Care of the Elderly attachment in a local district general hospital developed a good rapport with one of the female patients on the ward, who had been an inpatient during his entire attachment.
The student had been very supportive of the patient when decisions were being made about her future accommodation. Her family had different preferences for her.
On the day of her discharge, to show her appreciation, and much to the surprise of the student, the patient offered him a free stay in her Spanish villa for a week during the summer. With finances being tight, the student was very grateful for the offer and immediately accepted with much gratitude.
However, when the patient's family became aware of this, they complained to the trust, suggesting that the student had taken advantage of their mother's vulnerability and had abused his position. The student was asked to comment and explain himself. He immediately contacted the MDU for advice.
The MDU adviser explained that although accepting gifts from patients is not forbidden, doctors have to be careful as to what they accept and how this is recorded. The GMC states that doctors must not accept gifts from patients or colleagues if it is an inducement, gift or hospitality that may affect or be seen to affect the way that person is treated.
In this instance, the gift was seen to be in excess of that which would be expected as a token of appreciation and there was a danger that the student could be vulnerable to criticism that he was taking advantage of the patient's position.
He was advised to reflect on the incident, and apologise for his actions. The MDU adviser also suggested that he review the relevant GMC guidance and contact the trust's patient liaison service to see whether they had a policy on accepting gifts, and whether a gift register existed for members of staff to record personal gifts.
In his statement, the student apologised and explained that, with hindsight, he should not have accepted the gift as he could appreciate this may raise concerns about his professionalism. The matter was closed with no further action.
What does the guidance say?
As well as its main guidance Good medical practice, the GMC has published specific advice on gifts and conflicts of interest, which states that if you do receive a gift or bequest from a patient or relative, you should consider any potential damage accepting the gift could cause to the patient's trust, and to the public's trust in the profession.
In England, the General Medical Services contract stipulates that GPs who are given gifts worth £100 or more must enter these onto a register. Equivalent sets of regulations are in place in Scotland, Wales and Northern Ireland.
NHS England's recently published guidance on managing conflicts of interest, which came into effect on 1 June 2017, advises that gifts valued over £50 should be treated with caution, and should only be accepted on behalf of an organisation, and not by individual NHS staff. They should also be declared.
Offers of hospitality should only accepted if there is a legitimate business reason, for example attending or speaking at a professional conference.
It's also important for students and qualified doctors to keep a record of any gifts they receive for their appraisal and revalidation. Keep any thank you letters and other tokens of appreciation, as this provides valuable colleague and patient feedback.
Dr Kathryn Leask
BSc (Hons) MBChB (Hons) LLB MA MRCPCH FFFLM DMedEth
Kathryn has been a medico-legal adviser with the MDU since 2007 and is a team leader, trainer and mentor in the medical advisory department. Before joining the MDU, she worked in paediatrics gaining her MRCPCH in 2002 and did her specialty training in clinical genetics. She has an MA in Health Care Ethics and Law, a Bachelor of Law and a Professional Doctorate in Medical Ethics. She is also a fellow of the Faculty of Forensic and Legal Medicine and has previously been an examiner and Deputy Chief Examiner for the faculty exam. Kathryn is currently a member of the faculty's Training and Education Subcommittee.
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