Grateful Patients

May 31, 2013

By Joseph Carrese, MD, MPH


The recent NYT piece about Hugette Clark and her relationship with medical and administrative staff at Beth Israel Medical Center raises important questions about the phenomenon of grateful patient philanthropy in the context of on-going clinical care. How should doctors and other health care professionals conduct themselves in these situations?


Findings reported in our recently published study (Wright SM, Wolfe L, Stewart R, Flynn JA, Paisner R, Rum S, Parson G, Carrese JA. Ethical Concerns Related to Grateful Patient Philanthropy: The Physician’s Perspective. J Gen Intern Med. 28(5):645-51) indicate that physicians worry their relationship with patients might be transformed unfavourably as a result of a philanthropic gift. Specifically, physicians were concerned that the physician-patient relationship might be tainted, that patient expectations could change, and that they may feel pressure to treat patients who give money differently than they treat other patients. The doctors we interviewed also expressed concern about asking for and accepting gifts when patients were more vulnerable (e.g., hospitalized and sick).


The AMA’s Council on Ethical and Judicial Affairs advises the following: “Physicians should avoid directly soliciting their own patients, especially at the time of a clinical encounter. They should reinforce the trust that is the foundation of the patient-physician relationship by being clear that the patient’s welfare is the primary priority and that patients need not contribute in order to continue receiving the same quality of care.”


As reported, it appears that the medical and administrative staff at Beth Israel Medical Center did not adhere to these standards of conduct regarding their relationship with Ms. Clark. It appears that at some point in the 20 year hospitalization the primary focus of the relationship became cultivating and soliciting philanthropic gifts, rather than their fiduciary responsibility to prioritize her welfare. It appears that their clinical relationship with her and her desire to stay in the hospital were used as points of leverage to pursue this gift-giving agenda. If true, this undermines claims that her gifts were given freely and purely voluntarily. Finally, this case raises questions of justice and best use of limited resources. Is having a patient stay in an acute hospital bed for 20 years an ethically defensible use of such a scarce resource, a resource that might have been used by many other patients in need over that period of time?


This case presents an opportunity to reflect and learn, and an opportunity for health care professionals to re-commit themselves to the highest ethical and professional standards when it comes to their relationships with patients. Society expects no less, and patients, of course, deserve it.


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Joseph Carrese, MD, MPH
Division of General Internal Medicine and Berman Institute of Bioethics
Johns Hopkins University

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