Gifts

If they are in general practice long enough in any one place all doctors receive gifts from their patients. General practitioners, living as they do with a particular population for perhaps two or three decades, get used to the various manifestations of patient gratitude that come their way. Among the more unusual items that I have been given are a leather jacket, two original oil paintings, an electronic chess set, a wall hanging with real peacock feathers, and a light up model of the Taj Mahal. Chocolates, small items of clothing, and alcohol are more standard.

It is interesting to reflect on the meaning that lies behind the giving of a gift by a patient. Such giving can be broadly divided into three catgories. Firstly, there is the simple and genuine expression of gratitude for some service rendered, which is perceived to be above the ordinary. This is one of those small and rewarding pleasures of medical practice that help maintain the doctor's faith in human nature. It may follow an event which for the doctor was a perfectly normal aspect of his work, but which clearly had special importance for the patient. Rarely does the deed justify the gift, but it is a churlish doctor who does not accept it gratefully.

A wallet and key holder, for example, were given to me by a middle aged couple after I had agreed to issue sick notes to the husband, who had a moderate degree of ischaemic heart disease, so that he could stay at home to look after his extremely psychologically disabled wife. The chess set is another item in this category, being passed on to me by the widow of a man whose terminal care I had been involved in briefly. He had been playing it on one of my visits before he became too ill and I had asked him how it worked. The leather jacket came from the son in law of an elderly woman whom I helped to get a place in a nursing home when her arthritis became too severe for her to continue to live in her warden assisted flat.

Even more undeserved and embarrassing gifts came my way when I was on sabbatical leave in Nigeria helping to run a community health programme. After one visit to a bush clinic with a British pastor and his wife, who were in the country for only a few weeks, we were presented with several bunches of bananas, some pineapples, and two live chickens. When we returned to the city I had to persuade some of the Nigerian staff to take the chickens; the pastor's wife was horrified at the idea of killing and preparing them, a fact which completely bemused the Africans. It was difficult to explain that the British get their chickens ready prepared.

The second category is what could be called the routine gift, which is given every year at Christmas as a sort of thank you for services rendered during the year, usually chocolates or alcohol. In my practice these gifts usually come from old ladies whom I have seen several times during the year to try and control their heart failure or their diabetes or make their osteoarthritis a bit more bearable or their chronic bronchitis less troublesome. The other major group here are Asian patients, who never fail to give gifts at Christmas time. I have never worked out whether it is as a mark of acknowledgment from a Sikh or Moslem family that they are now inhabitants of a Christian culture or whether it is because in their home cultures they would pay for medical treatment. Often they bring back interesting gifts from India. The peacock wall hanging was one such; another that adorns my consulting room wall is a beaten metal engraving of the Taj Mahal.

The third and final category of gift is more complex and creates mixed feelings. It is the gift that is used as some kind of bribe or pay off. The classical use of this manoeuvre is when an unnecessary home visit has been asked for. The doctor, playing it by the book, has dealt with the presenting complaint reasonably courteously and is about to reprimand the patient for an unnecessary call when, with a fine sense of timing, he or she produces a gift, saying: “Sorry to have called you out doctor.” A colleague in a rural practice told me how he was once given a brace of pheasants by a lord of the manor who could perfectly easily have come to the surgery, and I have received boxes of sweets and chocolates that have been offered in this category. A female patient, whose elderly mother I had just discovered had linitis plastica, tried to extract a promise that I would not tell her she had cancer. Of course, I could make no such promise, but said that I would not announce the news unless specifically asked. Presumably thinking that she had increased the emotional pressure of her appeal, the daughter then gave me a bottle of wine.

Whatever category they come in, the number of gifts a doctor receives is likely to outnumber the complaints by more than 10 to one. Add the number of thank you letters and cards and the ratio is even greater. It is good to remember this at times of low morale.—HUW MORGAN is a general practitioner in Bristol