28 February 2009


It's the weekend and Dr Grumble has taken the bottle of champagne he was given by a patient earlier in the week home. The plan was to celebrate one of the Grumble children's birthday. No worries. What a nice present. But then Dr Grumble took a careful look at the champagne. It looked rather special. It is rather special. A quick googling and it is apparent that this is no ordinary supermarket champagne. It is from a good house and from a top vintage. It sells for up to £100 a bottle. Is that OK? Dr Grumble is uncomfortable. What are the rules? Is he allowed to accept gifts of such value from NHS patients? Is he allowed to accept gifts at all? He actually doesn't know. As is often the case gifts from patients can be rather unexpected and turning them down is awkward, very awkward. Dr Grumble's patient was plainly not wealthy. Dr Grumble did very little for her. He made her better but any competent doctor could have done the same. He treated her well but he did not spend long with her. He did not give her anything extra. And she is so well she has been discharged from the Grumble care. But it is worrying that the bottle she gave is worth £100. It's very nice that she thanked Dr Grumble but a nice letter would have been just as good. But she obviously wanted to do more than that. And Dr G thinks she should be allowed to. He has photocopied the champagne label and put it in his appraisal folder. He is not going to keep this gift a secret. It will be above board and if there is any trouble he will offer to send the patient a cheque for the champagne that Grumble is now intent on drinking.

Do such things happen often? It seems they do. A GP acquaintance has been given £1000 by a patient to spend on a holiday. The GP is uncomfortable. The patient has no relatives. She is grateful to the GP. Her money will be left to a charity when she dies. She wants the GP to have a holiday with her money. But do the rules allow that? Dr G certainly has no idea. What could be the best solution to this problem? Surely it is to put the money to a good cause within the GP practice. Yes, that's the answer. Buy some medical equipment with the money. But when this was suggested to the old lady tears welled up in her eyes. It was not what she wanted. She wants her GP to enjoy herself and take a holiday. Now, if the GP refuses this lady will certainly be upset. And surely there is nothing stopping her from leaving some of her money to the GP when she dies. And presumably there is nothing stopping the GP from accepting it. But how much nicer for the patient to see her GP take a holiday while she is still alive. But what about the rules?

A couple of weeks ago a patient came to see Dr G privately. Until recently Dr Grumble did not see any private patients but there is a need. This particular patient was not eligible for NHS care. He was a very ordinary man from abroad and plainly not well off. Dr Grumble put in a small bill. As it turned out an English friend was paying and a letter came back to Dr G with a cheque for three times the amount Dr Grumble had charged. The friend had clearly realised that Dr Grumble had wanted to undercharge this patient and the friend was having none of it. He wrote thanking Dr Grumble for the care he had given and stated firmly that the advice was worth three times what Grumble had charged and enclosed a cheque accordingly.

These things do happen. There are actually a lot of nice people in this world. Sometimes it does not seem that way but there are. People sometimes want to give to others. Dr Grumble wanted to undercharge his impoverished patient. The patient's friend wanted to pay Dr Grumble more. The GP's elderly patient wants her to have a holiday and wants to pay for it. Sometimes human beings want to do things that are very nice. It is a very nice feature of human beings when you see it. It doesn't happen all that often but it does happen. We should allow it to happen. Rules or no rules Dr Grumble is going to drink his champagne.


Anonymous said...

You are perfectly entitled to enjoy these kind gifts, Dr Grumble.

Providing a gift does not result in preferential treatment then you are on reasonably safe grounds when you accept it.

Doctors have been warned to STOP accepting from freebies from drug companies, though.

May I respectfully suggest that you donate any gift which causes you to feel uncomfortable to the nursing staff - we would have few qualms about glugging a nice bottle of bubbly.........after finishing the shift, obviously.

Dr Grumble said...

Thank you for that reassurance, a&e charge nurse. I am often minded to share these gifts when the opportunity arises. I do see these presents as a general offering of thanks to the whole team. Patients do not necessarily realise how much their survival or otherwise depends on the team as a whole rather than any one individual. And I do pinch the odd Quality Street not really intended for me.

Anonymous said...

I once gave a present to a hospital doctor who was very nice as well as able and I felt I needed to say thank you. He was surprised but said thank you and accepted it. It would have been really embaressing if the doctor had rejected the present IMO. I think it would be insensitive if a doctor had said no when all the patient wants is to show that they are grateful. I do not know about the rules Dr G but in my opinion you did the right thing by accepting and by keeping a copy of the label in your appraisal folder ..now time to enjoy this champaigne .. this is what your patient intended afterall .. to say say thank you by giveing you back some of the joy they felt following your good services .. and you deserve it too, me thinks .. enjoy :-)

.. and you should see the presents Docs around the 'Golden Mile' of central London get! Sometimes 'obscene' is an understatement!

Anonymous said...

Enjoy the fizz guilt-free, Dr G. Judged from reading the blog over the last 18 months or so I suspect you have earned it several times over.

I would ask Mrs Dr Aust if she has ever been offered a gift, but she is crashed out with Baby Aust. The only one I can remember is a plant a couple of years back from a patient's relative, which we still have.

The Shrink said...

I'd also go with opening the bottle and enjoying the drink with your family. As you say, that's what your patient's wishes were.

Her care's manifestly not changed through the gift. Probity matters are satisfied with declaration in your Appraisal folder.

I'm with A&E Charge nurse though . . . although as Sam also says it's common for patients to express gratitude (saying thanks, or writing a letter, or through a gift), relationships with pharmaceutical companies are different.

So whilst I've happily accepted chocolates, flowers and drink from patients, I won't take even a biro or post-it note from drug reps.

Doc Doc said...

A&ECN is right, Ok to accept gifts and there is no limit to the amount.

Locally we are encouraged however to notify the PCT if we accept a gift worth over £25.

Gifts from drug companies etc frowned upon and definitely no to accepting gifts such as free membership to golf club/country club etc.

I receive many gifts at Xmas usually booze and cakes, not so good for the waist line!

Hope you enjoyed the champagne.