This article has been reproduced for study purposes only, and ...

This article has been reproduced for study purposes only, and comprises fair use under Copyright Act
Clear and Present Danger – 17 December 2008
Christmas is a time for giving and receiving — unless, of course, you are a GP. By Heather Ferguson
IMAGINE the look on the GP’s face when he unwrapped a rather unusual gift from a grateful patient.
There’s no doubt the sentiment was genuine — the GP had looked after the woman during her
prolonged convalescence from a total knee replacement, including several after‐hours home visits.
As a token of her thanks the patient presented the GP with a large, yellow cuckoo clock.
The GP contacted his medical defence organisation, MDA National, concerned that the gift could
alter the doctor‐patient relationship and create an expectation the patient would receive special
treatment.
He was also concerned that accepting the clock would breach his medical board’s code of conduct,
which states GPs should not accept gifts or other inducements. And then there was the matter of
aesthetics — the clock was very ugly.
Dr Sara Bird, medicolegal claims manager for MDA National, says the GP was advised it would be
reason able to return the clock to the patient, explaining that he was unable to accept the gift
because it may be in breach of his professional and ethical obligations.
But the GP did not want to upset the patient by returning the gift. He wanted to offer to pay the
patient for the gift but was worried the clock may have been quite expensive.
“MDA National advised the GP not to pay for the clock and recommended that he politely return it
to the patient as soon as possible,” Dr Bird says. “The GP said that he would consider this advice and
then decide what to do.”
A few weeks later the GP phoned back to say he had attempted to resolve the situation by offering
to pay the patient for the clock.
“Fortunately, the patient had refused payment and a compromise was reached whereby the patient
decided to donate the clock to the local charity shop,” Dr Bird says.
“The GP said that he was very happy with the resolution of the matter and noted, in passing, that
the cuckoo clock remained in the charity shop’s window.”
Aesthetic sensibilities aside, the GP had good reason to be hesitant about accepting an expensive
gift. To do so could breach his medical board’s code of conduct and the Australian Medical Council’s
draft code, Good Medical Practice. It states that doctors “must not encourage patients to give, lend
or bequeath money or gifts that will benefit you directly or indirectly”.
All MDOs advise against accepting expensive gifts from patients.
Ferguson H, 2008, Australian Doctor, Clear and present danger, 17 December 2008

Dr Paul Nisselle, general manager of clinical risk management with Avant, says it’s a line GPs
shouldn’t cross. He says examples of inappropriate gifts have included expensive wine and use of a
holiday apartment.
“It would be boorish not to accept a small box of chocolates from a pensioner patient. It would be a
boundary violation to accept a bottle of Grange,” he advises.
“Accepting a gift may suggest a willingness to move from a purely professional relationship to
something else.”
Dr Nisselle also advises against GPs giving presents to patients.
“If you give a gift to some patients, what are your selection criteria? What does that signal about the
relationship?”
But that doesn’t mean GPs can’t do something to make a patient feel special.
When he was in practice, Dr Nisselle made a point of taking his then pre‐teen children to visit a
couple of his nursing patients on Christmas Day. The patients had no relatives and were not
cognitively impaired. Dr Nisselle and his children would take some chocolates and perhaps some
flowers or a small pot plant for the patients.
“That was in part a learning experience for my kids, who would be coming straight from opening
pressies to see another side to Christmas, and in part to let the patients know that someone was
thinking of them,” he says.
“I think that’s different to giving gifts more generally.”
The RACGP has a less prescriptive approach to receiving gifts. It doesn’t consider it unethical for GPs
to receive gifts from patients or their family and friends, although it does state that such gifts should
not impact in any way on the doctor‐ patient relationship.
The college says because general practice is an ethical profession, GPs must act in the best interests
of their patients.
RACGP president Dr Chris Mitchell says gifts can also be a poignant link to patients who are no
longer around.
“A few years ago I was given a beautiful painting from a patient I had diagnosed with a terminal
cancer,” he says. “The artist had escaped from Russia and had used this work to gain entrance to a
Paris school of art.
“It was a wonderful forest scene of country he had walked through on his way out, with everything
he owned on his back, including his paint brushes. It hangs over my fireplace as a reminder to me of
a wonderful man.”
Professor Claire Jackson, a member of the RACGP Queensland faculty board, says her most
memorable gift from a patient doesn’t bring back such happy memories.
Ferguson H, 2008, Australian Doctor, Clear and present danger, 17 December 2008

At first the gift had all the hallmarks of proving worthy of fond anecdotes: a patient had shot a duck
for her and Professor Jackson was looking forward to serving it for Christmas dinner.
“I cooked it with all this care but it was horrible and full of buckshot,” she says.
“So for Christmas I gave my family lead poisoning. [If I had known] I would have just given up and left
it in the bin at work.”
On reflection, Professor Jackson thinks her patient may have shot the unfortunate fowl — which she
had to pluck — in a Brisbane sub urban park.
“The patient was a delightful guy … but he had a significant drug problem and the duck was clearly
shot by an amateur person,” she says.
RDAA president Dr Nola Maxfield has also had some dubious experiences with gifts of food.
“I had one elderly man who insisted on bringing preserves he’d made himself,” she says. “The only
problem is the date they were made was usually two years beforehand. I used to thank him very
kindly, then take them home and put them in the compost.
“I had another man who used to bring me a fruit cake he’d made himself. He’d tell me how during
the year he’d marinate the fruit in alcohol for months on end.”
But Dr Maxfield, who practises in Wonthaggi in Victoria’s south Gippsland region, says home‐made
gifts are the most touching because they show the patient has thought about you.
She fondly recalls a load of seedlings she received for her vegie garden, all nicely labelled.
On another occasion a small gift of flowers proved to be particularly touching.
“An older lady came back for the results of her CT scan,” Dr Maxfield says. “Obviously she knew they
were not going to be good but she still gave me a posy of flowers from her garden.”
AMA president Dr Rosanna Capolingua says one year “dozens and dozens” of petunia seedlings were
left at her front door on Christmas Eve. There were so many trays of seedlings that Dr Capolingua
was able to plant a large, colourful show in her front and back gardens.
“My garden was absolutely florid with colour. It was just gorgeous,” she says.
However, Dr Capolingua says she usually feels uncomfortable being given gifts because she believes
it is a gift that a patient wants to come to see you.
“I know it sounds corny but it’s true.”
But for other GPs, Dr Capolingua says the AMA’s position on receiving gifts depends on the scenario
and the gift. For example, if a male patient offered a gift to a female doctor and there were
indications the patient was attracted to the doctor it would be wise to refuse.
“I know of instances … where colleagues have refused to accept gifts presented on that basis,” she
says. “But in general cases where the patient has given a gift that is not of monetary value … then
sometimes you have to be humble and accept the gift.”
Ferguson H, 2008, Australian Doctor, Clear and present danger, 17 December 2008

OVERSEAS GIFTS
Associate Professor John Gullotta, Sydney GP and federal AMA councillor
Professor Gullotta has received his share of overseas souvenirs ‐‐ tea towels, pens and even a bust of
Hippocrates from Greece. There's also been a steady stream of homemade cakes, chocolates and
biscuits to keep up his calorie intake.
"However, being [of] Sicilian heritage and having many patients from Italy I am proudly given a
selection of home‐grown vegetables, eggs and fruit, which are very yummy and good for you as
well," Professor Gullotta says.
But he could happily do without the "rocket fuel" ‐‐ homemade wine and spirits.
"Some can be very good and very palatable. [Unfortunately], the majority of batches ... have a much
better purpose as drain cleaner."
FEW AND FAR BETWEEN
Dr John Hall, GP in Oakey, Queensland
DR Hall's patients have no excuse for forgetting his name, thanks to one of his more creative
patients.
"I have a very elaborate carving on my desk … with my name [carved and painted] in gold. It looks
like one of those Indonesian carvings," he says. "Apparently [the patient] made one for all new
doctors who came to the practice."
However, Dr Hall, says he doesn't get many presents.
"I get the odd jar of pickles. I also got a case of wine from someone at a local winery [whom I treated
for] pneumonia.
"Maybe [gifts were] more common in the days before Medicare when if someone could not afford
to pay they'd bring vegies or a pig."
CLEAR GUIDELINES
Dr Christine Boyce, Lenah Valley, Hobart
Dr Boyce gives her patients clear instructions about what she can accept as gifts, usually restricting
them to some edible goodies at Christmas or home‐grown flowers, fruit or vegetables.
But when she turned 40 she was willing to accept a more unusual present from one patient.
"I had this lovely African lady as a patient who always had these henna tattoos when she came in
and I was forever telling her how much I admired them," Dr Boyce says.
Ferguson H, 2008, Australian Doctor, Clear and present danger, 17 December 2008

"She said she would do one for me, but until my 40th birthday I had no real occasion where I
thought I would be sporting a henna tattoo. I had a dress‐up birthday [party] and I had a sari …
which I thought the henna tattoo would go really well with."
Dr Boyce and her daughter went around to the patient's home and had a nice time while the tattoo
was applied to her arm and hand.
"It was just beautiful," Dr Boyce says.
The tattoo lasted for a couple of weeks and proved an ideal way to help increase tolerance and
understanding of other cultures.
"I got lots of comments and questions [from other patients], so it was a good conversation starter
about patients from other cultures," Dr Boyce says.
NOTHING BEATS A THANK YOU LETTER
Dr John Kastrissios, GP in Springwood, outer Brisbane
KNOWN as JK or Dr John to his patients, Dr Kastrissios is still waiting to be offered an exotic car as a
gift. "I would love to be given a Ferrari but I don't think I would be able to accept it," he jokes.
Dr Kastrissios, this year's winner of the John Aloizos medal for outstanding contribution to the
division's network, says his practice receives the usual alcohol and chocolates as well as homecooked
meals and ethnic foods.
"The funniest things are T‐shirts with various colourful slogans," he says. "One had anatomical
pictures on it to assist me with my diagnoses."
The T‐shirts create a bit of fun and laughter in practice. Dr Kastrissios has worn them on dress‐down
days, covering up with another shirt for the few patients who may not appreciate the humour.
He also made sure he wore the anatomical shirt on the day he performed a procedure on the patient
who gave it to him.
"She thought it was extremely funny."
But the presents Dr Kastrissios treasures the most are letters.
"The best thing is people who write thanking you for looking after them," he says.
Ferguson H, 2008, Australian Doctor, Clear and present danger, 17 December 2008