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Haslam's view: should we accept gifts from patients?

Gifts from patients can cause all manner of problems.

They are usually really well meant, offered in genuine gratitude, and carry wrapping paper but no ulterior motive, but nevertheless they can tie us up in knots. Should we accept? What precedent does this set? Do they leave us in some way indebted to the patient? Is it simply safer to decline politely?

One of the first presents I ever received from a patient was one of the most generous, most well meant, most inappropriate, and most bizarre of my career. I was working in a mental health unit and we had a number of patients who were inpatients for a very long time. This particular patient was very prim, very quietly spoken, and initially very depressed. After much counselling, high doses of medication and even a course of ECT she made a quite remarkable recovery.

On the day she was due to be discharged she asked to see me and matron. We met her in matron's office. She told us how grateful she was for our care, and that she would like to give us something.

I remember her exact words. ‘I know it used to be traditional for a grateful patient to give some produce from their work. Well, I'm not a farmer or a gardener so I have no produce, but I hope you will accept these.'

And she passed us each a year's free pass to the cinema where she was a manager with a wish that we would have the time to be able to use it. Matron spluttered. Despite a lifetime working in psychiatry she was even primmer than the patient, and she read the pass before I did. It turned out that our patient was the manager of a pornographic cinema club – a club whose next showing was (and I wish I was making this up) a production with the unforgettable title of Danish Dentist on the Job.

Obviously I never used the ticket. I rather doubt that matron did either. But the way in which it was handed over made me very aware that it was meant with genuine kindness. She had nothing else she could give.

And then there were the bird prints. When I first started work in general practice our premises were shockingly poor. My consultation room had numerous cracks and holes in the plaster. As we were shortly due to move out into a new health centre I patched them up in the easiest way I could, by simply sticking a series of prints of birds over the damaged patches of plaster. It wasn't that I was a bird enthusiast. It was simply that a drug company was using bird prints to advertise one of their products and they kept turning up in the post.

And so a grateful patient, noticed these, concluded that birds were a major passion of mine, and for Christmas that first year presented me with a beautiful book on British Bird Life. I was deeply touched, and thanked her effusively. The result – for the next seven or eight years I got a bird book every Christmas.

It was certainly very generous, but there was no way I could ever let on.

And the same went for the weekly jar of kipper paté that I was given throughout almost the whole of my trainee year. If only I had said that I didn't like kipper paté, my wife and I would have been spared all those jars. But I had said that I was grateful – for the simple reason that I was grateful. For the thought. Just not for the paté.

It's not that I'm ungrateful. It really isn't. You see what I mean about gifts causing dilemmas. But there are many worse dilemmas to have, aren't there?

I was deeply touched...it was certainly very generous, but there was no way I could ever let on

Author

Professor David Haslam CBE
FRCGP
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; national clinical adviser to the Healthcare Commission; and Visiting Professor at de Montfort University, Leicester

Haslam's view

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