Not too long ago I was out shopping with a friend and was surprised when she said she needed to buy a gift for her dentist. I admit I was a little stunned – I’ve never considered giving a gift to my dentist before. In fact, other than tips in a restaurant, my annual non-family, non-friend gift-giving list is very short. Apparently, this friend of mine gives small gifts to many of the people in her life including her doctor, her son’s teacher, and the even kid who cuts the lawn. To me, unless its Christmas time or perhaps someone’s birthday, a gift is inappropriate. But when I confronted my friend, her attitude was wholly different. “I love giving gifts to people who do great stuff for me,” she said. “It’s my way of saying thanks. And besides, I never spend more than a few dollars.”
Indeed, I’m not the first one to have such thoughts and I won’t be the last. Lately, many people in the medical community are talking about whether or not it’s acceptable for a medical professional to accept a gift. Many believe the issue is black and white – that no gift should ever be accepted, no matter the value, while others think the issue is being blown out of proportion and that’s it’s fine to accept something offered in thanks. For me though, it’s a question of ethics. It’s a question of maintaining professional boundaries and not setting an expectation that could be taken inappropriately. While it may be ok to accept a small gift like a card or even a small box of candy, what should you do when offered a bigger-ticket item like an expensive watch or game tickets?
Unfortunately, it’s not so simple. For medical professionals, especially those in mental health, accepting or refusing a gift can substantially influence the patient-doctor relationship and in some cases, destroy it. According to Dr. David Brendel, a psychiatry professor with the Harvard Medical School, most gifts are in gratitude, as thanks for a great service or a job well done. “Rejecting it (a gift) could be quite disruptive to the patient doctor relationship.” On the other hand, he opined that not rejecting a gift could appear exploitative or could indeed violate major boundaries.
One would expect that laws exist on whether doctors and other medical professionals can reasonably accept cash or gifts but surprisingly, they don’t. A few years ago, a medical journal in BC published a list of ethical guidelines set by each province’s regulatory bodies on the question of receiving gifts as medical staff. The laws focus on whether or not the doctor accepting the gift would be acting in the patient’s best interests by doing so. Indeed, the most important factor in the decision should be whether the best interests of the patient are taken into consideration. Specifically, in cases of mental health, refusing a gift from a patient could set the relationship back diminishing trust which may have taken substantial time to establish. Another factor concerns the monetary value of the gift itself and whether it would qualify as ‘extravagant’. In such a case, most people would agree the giver should be let down softly.
If someone did want to show gratitude without being inappropriate, it would be wise to consider how it would feel if the ‘shoe were on the other foot’ so to speak. It’s also important to consider the situation at the office; many companies expressly forbid accepting gifts and to do so could put the receiver’s job in serious jeopardy. So, once you’ve ascertained that it won’t be awkward or contrary to regs, make sure any gift you do give is modest in value and doesn’t make people feel uncomfortable in any form at all.
In general, I think tips should only be given when service rendered is far above what is normally expected. Also, at Christmas, I think it would be ok to give a small gift to someone who has made you particularly happy, in fact thinking about it just now, I once gave an interesting book to a surgeon.
In summary, it’s your choice absolutely whether or not you give a tip or a gift. Decide with your heart, but take the time to consider the effect it will have on the recipient. Don’t every feel pressured – some people think tips are obligatory but if they were, they wouldn’t be optional. After all, the purpose of tips is to reward great service. Some people say that’s what tips stands for.. TIPS – To Insure Prompt Service.