Accepting Thank You Gifts From Patients: A Primer
Basic considerations regarding ethics, practice culture, and licensure.
By Paul J. Welk, PT, JD*
All physical therapy private practices presumably strive to provide superior clinical services with the goal of having patients highly satisfied with their overall physical therapy experience.
From time to time, achieving this goal creates a situation in which a patient desires to give a gift to his or her physical therapist. Such gifts can range anywhere from a cookie tray to a small dollar value restaurant gift card to a more significant cash amount. Staff members receiving gifts from patients, in whatever form, creates a number of issues that must be considered by the practice.
As an initial consideration, the practice must decide whether it will allow its staff to accept any gifts from patients or whether it prefers a blanket restriction on the acceptance of any gifts from patients by staff. In doing so, the practice should give consideration to whether a blanket policy of declining all gifts could potentially be offensive to a patient desiring to provide a gift. A refusal by a staff member to accept a gift could, for example, cause harm to the ongoing therapist–patient relationship if the patient is offended by the refusal. If a practice elects to have a blanket prohibition on staff receiving gifts, the risk of offending a patient can be mitigated by providing talking points to staff as to why gifts cannot be accepted. Employing this strategy allows a consistent and accurate message to be delivered to patients. In addition, the practice could include a statement in its patient registration packet noting that as a general rule policy staff are prohibited from accepting gifts from patients. In addition to ethical and legal concerns, some practices elect not to allow staff to receive gifts because they believe this devalues the care that a physical therapist has provided to its patients. Finally, a practice may elect to prohibit patient gifts to avoid the risk of creating a hostile work environment where, for example, a treating physical therapist receives a gift from a patient while the physical therapist assistant who worked with the same patient does not.
If the practice elects to allow staff to receive gifts from patients, there are a number of issues to consider. Initially, the American Physical Therapy Association Code of Ethics for the Physical Therapist (“Code”) provides in part that “[p]hysical therapists shall seek remuneration as is deserved and reasonable for physical therapist services” and “[p]hysical therapists shall not accept gifts or other considerations that influence or give an appearance of influencing their professional judgment.”1 In part, these principles place at issue the reason why the gift was received, which would require a case-by-case analysis based on the particular circumstances. For example, a gift intended to influence a physical therapist’s clinical decision to extend a plan of care beyond that which is medically necessary is problematic. As another example, a gift could be given in an attempt to influence preferential treatment for the patient, such as receiving favorable scheduled treatment times when compared to other patients. Such gifts, which could influence the judgment of the recipient, may be viewed differently than a gift that was clearly in appreciation of the services received, such as sending a fruit basket to all staff upon discharge. In addition to the Code, many state physical therapy practice acts and regulations incorporate, directly or indirectly, physical therapy professional ethics into their disciplinary provisions. These laws, rules, and regulations would need to be considered when assessing the issue of patient gifts. For example, the Pennsylvania Physical Therapy Practice Act provides that “[un]professional conduct shall include any departure from or failure to conform to…recognized standards of ethics of the physical therapy professional…”2
Once a private practice has determined its position on the acceptance of patient gifts, it is best to create a written policy that is acknowledged in writing by all employees. The policy should consider a number of elements. Initially, it is important that the employees not solicit gifts and that any idea of giving a gift be initiated by the patient. The policy should also consider differentiating broad categories of gifts and potentially treating them differently. For example, a policy may prohibit gifts such as cash, or gifts that are personal to the individual, for example, a wristwatch, or may otherwise limit the dollar amount of a gift that a staff member can accept. If a patient desires to provide a cash gift, a policy can provide for a mechanism whereby the patient can make a charitable donation in the name of the practice or the staff member to a charity of the patient’s choice. The practice may choose to provide a list of preferred charities that are of particular interest to the practice should a patient wish to make such contribution. The policy should also consider how gifts will be tracked or otherwise documented. For example, the policy may require that all gifts be documented on a designated form and presented to the compliance officer or practice owner for review. As an additional step, a policy may require that a gifting form be signed by the patient, or where appropriate the patient’s power of attorney or legal guardian, to acknowledge the gift. Depending on the patient population, having this acknowledgment may be important should a family member raise concerns regarding why a patient made a donation to a particular charity in the name of the practice. Finally, for any private practices that contract staff or services to other facilities such as a hospital, including a process that requires a review of any underlying facility’s policy will assist in assuring compliance. In general, larger hospital systems and other similar organizations often have robust policies addressing patient gifts.
In summary, when considering how a practice chooses to address patient gifts, the practice should first determine whether to permit gift giving at all. If gift giving is permitted, appropriate policy or policies should be developed to govern the process, giving consideration to the legal and ethical obligations of the staff and the overall work environment of the practice.
1American Physical Therapy Association Code of Ethics for the Physical Therapist. Available at www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Ethics/CodeofEthics.pdf. Accessed February 3, 2019.
2Pennsylvania Physical Therapy Practice Act, Section 11(a)(6).
Paul J. Welk, PT, JD, is a Private Practice Section member and an attorney with Tucker Arensberg, P.C. where he frequently advises physical therapy private practices in the areas of corporate and healthcare law. Questions and comments can be directed to firstname.lastname@example.org or (412) 594-5536.
*Please note that this article is not intended to, and does not, serve as legal advice to the reader but is for general information purposes only.
*This author has a professional affiliation with this subject.