As Christmas approaches, many dental professionals may be given gifts from appreciative patients. David Lauder reviews the rules on accepting gifts from patients and pharmaceutical firms.
At this time of year, patients often show their appreciation by giving you a gift. In a DDU survey of some 130 dental professionals in 2016, 78% had received at least one gift from a patient in the previous year. Chocolates and other edible gifts and alcohol were the most common gift but some presents were more unusual. One dental professional was given a pig’s head, while others received a pheasant, a puzzle and homemade Christmas decorations.
It’s really gratifying to be thanked by a patient. However, in the DDU’s experience of providing dentolegal advice to members, accepting gifts from patients can occasionally present ethical issues.
While accepting small gifts such as chocolates or a bottle of wine is unlikely to raise alarm bells, the DDU advises a cautious approach to accepting more unusual or expensive items. This is because difficulties can arise when the patient’s motive for gift giving might be unclear or misconstrued, or when the gift is expensive.
The General Dental Council’s Standards for the dental team states that: ‘You must refuse any gifts, payment or hospitality if accepting them could affect, or could appear to affect, your professional judgment’ (paragraph 1.7.5).
If a patient gives you a present, it may be advisable to ensure the patient understands their dental care would not be affected in any way by the gift. You may want to keep a record of these conversations, any correspondence, and the reasons for accepting the gift, if you did so.
At the same time, even small gifts could ring alarm bells in the context of other behaviour, for example, a gift from a patient you suspect has romantic feelings for you. In such situations it might be better to politely refuse the present.
If you are unsure about whether it is appropriate to accept a patient’s gift, it’s a good idea to seek an objective opinion from a colleague and get advice about the ethical implications from your dental defence organisation.
Professional contacts, such as pharmaceutical suppliers may want to treat dental professionals to hospitality or provide gifts. This can be problematic because of the perceived risk to dental professionals’ objectivity, including their prescribing habits, use of particular suppliers or other aspects of their clinical practice.
Section 300(4) of the Human Medicines Regulations 2012 states that: ‘A person qualified to prescribe or supply medicinal products may not solicit or accept any gift, pecuniary advantage, benefit or hospitality’ unless it is inexpensive and relevant to practice. In this context, hospitality includes sponsorship of attendance at a meeting or event and the payment of travel or accommodation expenses.
If in doubt, it may be necessary to politely decline a gift or offer of hospitality from a professional contact.
General medical practices have a contractual obligation to keep a register of gifts from patients, relatives, and people providing practice services that are worth more than £100. While there are no such obligations on dental practices, the DDU believes it is worth recording gifts, even those of low value, in case concerns are raised
The register could include the name of the donor and either their address or NHS number. It is advisable to warn the person offering a gift that this information will be recorded.
The fictional case example below is based on the types of cases the DDU sees.
A dentist developed a good rapport with an elderly female patient who was having restorative treatment carried out over a period of months.
At the end of the course of treatment, the patient said she was so delighted with the result that she would like to offer the dentist a free stay in her Spanish villa for a week during the summer. Somewhat put on the spot and slightly embarrassed by the offer, the dentist merely thanked the patient.
However, a few weeks later, the practice received a complaint from the patient’s family about the offer, suggesting that the dentist had taken advantage of their mother’s vulnerability and had abused his position. The dentist rang the DDU for advice.
The DDU adviser explained that the gift could be seen to be more than a simple token of appreciation and in light of the GDC guidance, there was a danger that he could be vulnerable to an allegation that he was taking advantage of the patient.
The dentist wrote to the patient explaining that family members had expressed their concern about the offer. Having carefully reflected of the situation, he thanked her but clarified that he wasn’t in a position to accept the stay in the villa. Nothing further was heard from the complainants.
The practice also reviewed and updated its policy on staff accepting gifts.
For more information visit www.theddu.com or call 0800 374 626.