Patients bearing gifts: are there strings attached?

BMJ 2005; 331 doi: 10.1136/bmj.331.7531.1527 (Published 22 December 2005)
Cite this as: BMJ 2005;331:1527

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  1. Sean A Spence, professor of general adult psychiatry (s.a.spence@sheffield.ac.uk)
  1. Academic Clinical Psychiatry, Division of Genomic Medicine, University of Sheffield, Sheffield S5 7JT
  • Accepted 4 October 2005

The giving of gifts is an ancient and widespread human activity. But when the gift is given by a patient to their doctor then there may be ethical and clinical questions to consider

The love embodied in the gift outlives the giver, affirms his life drive, and adds a sense of beauty to the endurance of life.1

It was Christmas Eve and the elderly man had walked in his pyjamas through the sleet and snow, until he reached the accident and emergency department. He already knew that he had cancer, but now he was in acute urinary retention. As luck would have it, the house surgeon who came to see him was the one he knew from the ward; they exchanged banter as the younger man sited a catheter. A few nights later, when the house surgeon was back on the ward, the elderly man called him over. He had a gift for him. It was a bottle of champagne. In his working life he had been the head waiter at a famous restaurant; this champagne was the favourite drink of a celebrity who had dined there. The houseman was speechless with emotion; he liked the man and knew he was about to die. It was the first gift he had received from a patient.

The meaning of gifts

What does it mean when a patient gives their doctor a gift? Often, it means “thank you for being there,” especially at a difficult time.2 3 The elderly man had walked through the snow, despite being in great pain. Perhaps his gift was offered in thanks for relief from that pain. Perhaps it was an attempt at being understood on another level: as someone who was not always old and ill, but who had worked long hours and earned respect as a head …

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