Tipping a doctor, acceptable?

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Specializes in Critical Care, Quality Imp, Education.

Hello

My Dad took my grandfather to his cardiologist a couple of days ago. My grandfather was there for a follow-up appointment after having a pacemaker inserted. Before the appointment, my grandfather went to the bank and removed $2000, not unusual for my grandfather who always carries a lot of cash. We don't like it but he does what he wants. At the cardiologist office, my dad sees my grandfather "palm" the money and says to the doctor, "doc, thanks for doing a great job."

Two questions, am I wrong for thinking that this is totally unethical and should I report this to the appropriate outlet, i.e. AMA, state board, etc?

Thanks

gtmoore, RN

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Hello

My Dad took my grandfather to his cardiologist a couple of days ago. My grandfather was there for a follow-up appointment after having a pacemaker inserted. Before the appointment, my grandfather went to the bank and removed $2000, not unusual for my grandfather who always carries a lot of cash. We don't like it but he does what he wants. At the cardiologist office, my dad sees my grandfather "palm" the money and says to the doctor, "doc, thanks for doing a great job."

Two questions, am I wrong for thinking that this is totally unethical and should I report this to the appropriate outlet, i.e. AMA, state board, etc?

Thanks

gtmoore, RN

I would talk to your grandfather first before doing anything. Find out exactly why and and for what he gave the money to the cardiologist for. If you find your grandfather did give $2000 as a gratuity, then I would agree that it was unethical for the cardiologist to accept this and the matter looked into.

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It would seem to me highly unethical for the doctor to accept such a gift. Cookies, chocolates ok, but $2000? I believe that's considered "conduct unbecoming" for nurses, seems like that would apply for doc's as well.

Find out for sure. AMA seems like a good resource. Then ask your grand-dad, and the Dr. Give the Dr a chance to return it, if it is indeed unethical according to the AMA for him to have accepted it.

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Specializes in OB, M/S, HH, Medical Imaging RN.
It would seem to me highly unethical for the doctor to accept such a gift. Cookies, chocolates ok, but $2000? I believe that's considered "conduct unbecoming" for nurses, seems like that would apply for doc's as well.

Find out for sure. AMA seems like a good resource. Then ask your grand-dad, and the Dr. Give the Dr a chance to return it, if it is indeed unethical according to the AMA for him to have accepted it.

:eek: If true that would be horribly unethical on the part of the cardiologist.

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Maybe your grandpa pays in cash for everything. What would you accomplish by reporting anyone? Is it your role to police anyone? Was any harm done? Just some questions to consider.

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Specializes in Med/Surg, Ortho.

I would also consider if there is a co-pay with or if he has insurance. I would hope the doctor would hold it on account for him if nothing else and apply it appropriately. If not then it should be returned to the patient, if nothing else via the son to put into account for the father. No way is it appropriate for a Dr to accept a "gratuity" like that.

Im pretty sure they fall under the same guidelines as nurses where tips and gratuities fall. It's an ethical issue.

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Specializes in Critical Care, Quality Imp, Education.

Thanks for all of your advice. I'll ask grandpa why he did it and look to see if the Dr applies it to his bill. Considering he is on Medicare and has secondary insurance, his share shouldn't be more than a couple hundred dollars. We'll see...

Thanks

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Specializes in Critical Care, Quality Imp, Education.

Surely if insurance is paying for the majority of the bill, you would be suspicous too if your family member did the same. It's not my role to police anyone, however, if my perception is right, a doctor took a tip which is unethical. A question for you to consider, is it ethical to tip police officers, teachers, or other professionals...

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I, personally, would never tip any physician. They're already wealthy enough.

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What would you accomplish by reporting anyone? Is it your role to police anyone? Was any harm done? Just some questions to consider.

wow randy, i'm surprised.....as a professional, why wouldn't you consider this bothersome? just as i would hate to think of a nurse accepting gratuities, i cringe just as much when thinking of a physician doing the same.

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Specializes in Med-Surg, ER.

here's the ama policy on the matter. hope this helps.

http://www.ama-assn.org/ama/noindex/category/11760.html

code of medical ethics

e-10.00 opinions on the patient-physician relationship

e-10.017 gifts from patients

gifts that patients offer to physicians are often an expression of appreciation and gratitude or a reflection of cultural tradition, and can enhance the patient-physician relationship.

some gifts signal psychological needs that require the physician's attention. some patients may attempt to influence care or to secure preferential treatment through the offering of gifts or cash. acceptance of such gifts is likely to damage the integrity of the patient-physician relationship.

physicians should make clear that gifts given to secure preferential treatment compromise their obligation to provide services in a fair manner.

there are no definitive rules to determine when a physician should or should not accept a gift. no fixed value determines the appropriateness or inappropriateness of a gift from a patient; however, the gift's value relative to the patient's or the physician's means should not be disproportionately or inappropriately large. one criterion is whether the physician would be comfortable if acceptance of the gift were known to colleagues or the public.

physicians should be cautious if patients discuss gifts in the context of a will. such discussions must not influence the patient's medical care.

if, after a patient's death, a physician should learn that he or she has been bequeathed a gift, the physician should consider declining the gift if the physician believes that its acceptance would present a significant hardship (financial or emotional) to the family.

the interaction of these various factors is complex and requires the physician to consider them sensitively. (i, ii) issued december 2003 based on the report "gifts from patients," adopted june 2003.

lee

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here's the ama policy on the matter. hope this helps.

http://www.ama-assn.org/ama/noindex/category/11760.html

code of medical ethics

there are no definitive rules to determine when a physician should or should not accept a gift. no fixed value determines the appropriateness or inappropriateness of a gift from a patient;

i'm really surprised at this. if, in fact, this money was a tip, it makes me wonder if the 'rules' for nurses accepting tips has changed.

i'm certain cardiologists make excellent money, and then for it to be o.k. for him to accept such generous gifts, as well, just seems unethical to me. so, will patients start to feel obligated to give their docs gifts now?

randy, i do agree that it is not our place to police anyone (other than ourselves), and if gifts are o.k., per the ama, there would probably be nothing accomplished by reporting this except to make grandpa pissed big time if he ever found out! and, i guess if a patient can afford it, s/he can give their money to whom they please.

guess it just galls me that this would be acceptable for physicians but not nurses! :angryfire

oops! had to edit to say i don't want any tips from my patients. would make me feel slimy. but it still galls me!!

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