A student working on a Care of the Elderly attachment in a local district general hospital developed a good rapport with one of the female patients on the ward who had been an inpatient during his entire attachment.
The student had been very supportive of the patient when decisions were being made about her future accommodation. Her family had different preferences for her. On the day of her discharge, to show her appreciation, and much to the surprise of the student, the patient offered him a free stay in her Spanish villa for a week during the summer. With finances being tight, the student was very grateful for this offer and immediately accepted with much gratitude.
However, when the patient's family became aware of this, they complained to the trust, suggesting that the student had taken advantage of their mother's vulnerability and had abused his position. The student was asked to comment and explain himself. He immediately contacted the MDU for advice.
The MDU adviser explained that although accepting gifts from patients is not forbidden, doctors have to be careful as to what they accept and how this is recorded. The GMC states that doctors must not accept gifts from patients, or colleagues, if it is an inducement, gift or hospitality that may affect or be seen to affect the way that person is treated.
This gift was seen to be in excess of that which would be expected as a token of appreciation and there was a danger that the student could be vulnerable to criticism that he was taking advantage of the patient's position.
He was advised to reflect on the incident, and apologise for his actions. The adviser also suggested that he review the relevant GMC guidance and contact the trust's patient liaison service to see whether they had a policy on accepting gifts, and whether a Gift Register existed for members of staff to record personal gifts. In his statement the student apologised and explained that with hindsight he should not have accepted the gift as he could appreciate this may raise concerns about his professionalism. The matter was closed with no further action.
In Good medical practice (2013) the GMC advises the following regarding honesty in financial dealings:
77. You must be honest in financial and commercial dealings with patients, employers, insurers and other organisations or individuals.
78. You must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients.
79. If you are faced with a conflict of interest, you must be open about the conflict, declaring your interest formally, and you should be prepared to exclude yourself from decision making.
80. You must not ask for or accept from patients, colleagues or others – any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients or commission services for patients. You must not offer these inducements.
It is important to note that students, who ultimately become GPs, under the rules of the General Medical Services contract, must keep a register of gifts that are worth £100 or more. Equivalent sets of regulations are in place in Scotland, Wales and Northern Ireland.
NHS England's guidance on managing conflicts of interest suggests that gifts valued over £50 should be treated with caution and should only be accepted on behalf of an organisation, and not by individual NHS staff. They should also be declared.
It is also important for students and qualified doctors to keep a record of any gifts they receive for their appraisal and revalidation. Keep any thank you letters and other tokens of appreciation, as this provides valuable colleague and patient feedback.
This is a fictional case compiled from actual cases from the MDU's files.
This guidance was correct at publication 27/06/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.