There’s No Crime Like the Presents

Aristoteles Giagounidis, MD
Head of the Department of Oncology, Haematology, and Palliative Care, Marien Hospital, Düsseldorf, Germany

I hope you had a wonderful holiday season, and, although the climate seems to be working constantly against it, I hope some of you experienced the oft-dreamt-of “white Christmas.”
In Europe, as in many other places where the coronavirus is still alarmingly present, we were advised not to hold large family gatherings. What a pity that the pandemic spared me from witnessing Auntie Ellie losing her dentures in the soup like last year, or my brother and brother-in-law fighting over politics.

You’ve probably received plenty of gifts this holiday season, but the statistics say that many (if not most) presents don’t make a splash. In fact, in 2015, The Daily Mail reported that 42% of women returned holiday gifts from their husbands. Data from Mercator Advisory Group show that, in the U.S., up to $3 billion in gift cards go unused each year!

How about gifts from our patients? Every year around this time, patients say, “Doctor, I wanted to thank you for all the great care you’ve provided over the past months and give you a small present which I hope you’ll enjoy. I’ve been told that you have a sweet tooth.” Then come the Belgian chocolates or vegan cookies. Other patients bring flowers, self-made paintings, or even self-authored books from patients or their relatives.

And then there is the alcohol. I never drank wine or beer until I was 38 years old, when a patient from Spain offered me two bottles of Ribera del Duero wine at each of our monthly appointments. I was too polite to refuse them, so they piled up in my basement until, at Christmas, my wife urged me to finally open a bottle for the occasion. I uncorked a Protos Gran Reserva and was stunned by the vintage’s incredible bouquet and taste. Now, I enjoy red wine immensely and have spent a small fortune on wine from Spain, Italy, France, Australia, South Africa, and the U.S.

If you’re a novice in the field, you might not realize how valuable the gift is until you check your local liquor store. I know colleagues who have received Dom Perignon, Château Pétrus, and rare single malt whiskies – gifts that easily exceed several hundred dollars.
That’s where things get complicated. Are doctors allowed to accept gifts from their patients? I surveyed international hematologists and compiled their answers here. You can make up your own mind as to whether you are disadvantaged or lucky.

Most countries seem to have relatively similar rules regarding acceptance of gifts. Gifts from the pharmaceutical industry are largely unacceptable, which is in stark contrast to what was permissible several decades ago. From the 1970s to the 1990s, most countries allowed pharmaceutical companies to spend large sums on the maintenance of good business relations with key opinion leaders. Invitations to NFL games, the Soccer World Cup, and even safaris in Central African wildlife reserves were fair game (pun intended).

However, there are some differences regarding acceptance of gifts from patients, as seen below. (Note that these are responses from international colleagues and may not represent the exact legal framework in the respective countries.)

Belgium: Acceptance of gifts is forbidden. My contact wrote: “Although the rule is strict, it will not be applied to sensible gifts, like chocolates or alcohol.”

Canada: The Canadian Medical Association does not address the practice of gift giving by patients in either its Code of Ethics or Charter of Shared Values. However, local regulations vary and the person I surveyed affirmed that cash gifts were forbidden in her region.

Czech Republic: There are no official rules or regulations. My contact wrote: “Very common gifts are eggs, cakes, cookies, honey, some vegetables, blueberries. Rabbits are less common. Recently, I received two carp. Nuts and apples are common during the fall and, closer to Christmas, cookies are much appreciated.”

France: Acceptance of modest gifts of moderate amount are allowed, but no specific value is provided. Hefty fines of up to €375,000 can be set in case of infraction – which the person I surveyed told me he had to look up.

Germany: Acceptance of gifts exceeding €50 is forbidden, even if the gift will be passed along (e.g., given to one’s assistant). Practically, things are handled less strictly, and many doctors tend to accept gifts of lower value.

Greece: There are no official regulations and reasonable gifts that reflect the country’s culture are accepted. My contact told me, “I can assure you that, over the last 30 years, I have never bought any of the following products from the market: fresh fish, chicken, honey, eggs, or olive oil.”

Italy: Presents valued above €200 are unacceptable. Common gifts are homemade wine and olive oil.

Israel: Acceptance of any gift is strictly prohibited. “The authorities are especially sensitive regarding cash and the penalty is hefty,” my contact wrote.

Japan: There are no official laws regarding doctors’ acceptance of gifts from patients; however, hospitals do not allow medical staff to receive gifts from patients or their relatives.

Portugal: According to a colleague, “We have a directive that we are not to keep gifts with a value greater than €20, but in practice nobody follows that. We are mainly given food – port, whiskey, chocolates, chestnuts, and home-baked biscuits are regularly offered. Some patients give freshly killed rabbit, chickens, game fowl, and fish. I have never received a live animal, but I have seen colleagues leave with live turkeys and hens!”

South Korea: There is strict interdiction of accepting patient gifts throughout medical care.

Switzerland: There are no official regulations, but hospitals have their own policies, such as forbidding gifts above 300 Swiss francs.

United Kingdom: Health care workers may accept unsolicited gifts from patients or their relatives provided this does not affect, or appear to affect, the way they prescribe, advise, treat, refer, or commission services for patients.

Looking at these responses, it seems that some countries handle presents to doctors sensibly while others seem to think that health care workers are subject to constant bribery.

On the other hand, there are the gifts given by doctors. How do I handle that? Well, remember that my name is Aristoteles A. N. Giagounidis – the N. stands for Nikolaus, which is Santa Claus’ name in Germany! During the Christmas season, my office is filled with presents and goodies for staff and patients. Long-term patients might get cookies or a bottle of wine, and my staff are looking forward to the traditional perfumes, soaps, travel goods, or gift cards.