What price a box of turkish delight?
Jonathan Tomlinson is one of the most eloquent, sensible defenders of the NHS today. Writing on his blog, A Better NHS, he recently tackled the embarrassment doctors feel about accepting gifts. Entitled Giving and Receiving, the post takes the form of a reconstructed dialogue between Jonathon and an erstwhile colleague who says, “Accept the presents graciously, it means a lot to them and it should mean a lot to you too. Your patients care about you, and caring for others is one of the things that makes a hard life a bit more bearable. For some of course, you’ll have gone the extra-mile or diagnosed them with something really important, and for others there’s precious little kindness in their lives and you’ve been a part of that. For you perhaps it’s just business as usual, but look at it from their perspective, it’s anything but business as usual, it’s incredibly important, and giving you a present is their way of letting you know that.”
It strikes me that the moral panic about receiving gifts from patients is probably quite peculiarly British. Is this because of the distance placed between the service rendered and the formal renumeration? Anything that could be perceived as renumeration from a patient feels rather furtive from the recipient’s point of view. For the giver, though, the lack of an itemised bill may incentivise the expression of gratitude in other non-monetary ways.
Privatised healthcare does not seem to feel the moral angst about receiving gifts as keenly. The guidelines on gifts from patients from the American Medical Association date back to 2003. They are non-prescriptive and only urge discretion in accepting gifts to ensure that the patient (or patient’s family is it is a bequest) will not suffer financial hardship. Before healthcare was nationalised in Britain, patients often paid their local doctor in produce or services rather than cash (admittedly this can’t strictly be considered a ‘gift’, although it is akin to what anthropologists call a ‘gift economy’).
The gift-economy in healthcare is still common in non-urban healthcare settings all over the world. Ian Cross blogged about his receiving bananas, sweet potatoes and sugar cane from a grateful patient at his Medicine Sans Frontieres practice in Swaziland.
I wonder if doctors in private practice in the UK notice a difference in the ways in which patients express gratitude compared to that in the NHS? I have heard of lavish gifts being given by private patients, but presumably if they choose to pay for treatment, affordability is less of an issue.
