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Have you ever given a patient money?

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  •  Anne 
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    Disability Insurance

    I’m thinking about this due to an interaction I had yesterday. Patient I have seen a few times now, older, worked in heavy manual labor jobs his whole life, now with multiple orthopedic and musculoskeletal issues, has had a couple joints replaced and a few more to go, lives on his limited SSI, has a paid for small home, does not smoke/drink/any other wasteful habits, makes extra money as he can selling stuff at flea markets. I can’t imagine he ever made too much money and I doubt he has any savings. Nice guy, really doesn’t ask for much. Yesterday he asked me if I could complete his handicap placard paperwork and as I was completing it he said “can you date it for the end of the month? I won’t have the money to take it in until then.” It costs $5. The thought went through my brain to just give him $5 (or even 10!) with the paperwork. I don’t generally carry money with me in clinic so I didn’t (and I’m sure my workplace has a policy against this, and yes I know no good deed goes unpunished) but I’m curious…have you ever given a patient money? I only saw this happen once in residency, an attending slipped a longtime patient who was going through a layoff and didn’t have the money to pay a copay at some money–I think it was about $20.

    I googled the topic as well to see what was out there and found this: https://well.blogs.nytimes.com/2014/01/30/when-doctors-give-patients-money/

    Curious to hear people’s thoughts, past experiences (good and bad), words of wisdom, etc.

    #179564 Reply
     HikingDO 
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    Status: Physician
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    No, in my opinion this crosses a huge line. I’ll try to get them assistance if they need it, but I’ve never given them cash. I’ve also been given cash in a Christmas card by patients a few times, and returned it to them immediately letting them know that I appreciate the gesture, but I can’t accept it.

    #179572 Reply
    Liked by Tim, Zaphod, ENT Doc, Anne
     G 
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    No, although there have been a few times where I asked that the patient not be charged.

    More frequently, I inform patients that they came to a hospital not a bank and they need to find a friend or not smoke tomorrow so that they can afford their $4×2 rx.

    I suspect it is certainly dependent on your practice….

    #179579 Reply
    Liked by CordMcNally, Anne
    MPMD MPMD 
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    When I was a med student shadowing in the ED there was a guy there being treated for minor injuries after a house fire. Both his kids and wife were in the burn unit for inhalation and he had lost everything, was sitting there in paper scrubs as obviously his clothes were ruined. The ED staff passed an envelope around and I think ended up handing him like $1k. That was pretty human if you ask me.

    To the original question: I don’t. I have been tempted several times but have resisted. Honestly I am most tempted not by the saddest cases but by things that would streamline dispo. Example a homeless pt w/ cellulitis who could be rx’ed w/ a $4 rx from Target but repeatedly states they won’t leave b/c they don’t have money to fill it. I have been tempted but haven’t given in.

    It helps that my shop is loaded and tends to have lots of resources to deal with this — vouchers, SW assistance etc.

    I don’t agree that it crosses some kind of ethical or professional line. The issue is more appropriate case selection and the slippery slope argument to me. It would really suck/be uncomfortable if the guy came back in and said “hey you gave me a few bucks last time doc, how about a little stimmy again?”

    #179583 Reply
    ENT Doc ENT Doc 
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    I would not, could not give them cash

    Not in my clinic, or for a rash

    Not for meds

    Or for some booze

    Not for gum

    Or nice new shoes

    There are other ways

    To lend a hand

    But no cash to patients

    My Pal, Anne  😉

    CordMcNally CordMcNally 
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    Status: Physician
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    I’ve been tempted but about 99% of the patients I see that say they can’t get their $4 prescription could get it if they didn’t buy cigarettes for that day.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #179591 Reply
    CordMcNally CordMcNally 
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    Honestly I am most tempted not by the saddest cases but by things that would streamline dispo. Example a homeless pt w/ cellulitis who could be rx’ed w/ a $4 rx from Target but repeatedly states they won’t leave b/c they don’t have money to fill it. I have been tempted but haven’t given in.

    Click to expand…

    These people quickly change my perception of them. If they say they won’t leave, I discharge them then call security to escort them out. I refuse to be taken hostage by patients like this.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #179592 Reply
    Drop it into MD Drop it into MD 
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    I would not, could not give them cash

    Not in my clinic, or for a rash

    Not for meds

    Or for some booze

    Not for gum

    Or nice new shoes

    There are other ways

    To lend a hand

    But no cash to patients

    My Pal, Anne  😉

    Click to expand…

    Looking for a new side hustle?

    #179597 Reply
     Peds 
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    Joined: 01/08/2016

    To a patient no, to each their own.
    I have paid someone’s parking ($5) once.

    #179599 Reply
     IntensiveCareBear 
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    Splash Refinancing Bonus

    You can’t play favorites or case-by-case. You are trying to intertwine your professional life an personal life. If you want to find that charity feeling, give anonymously or get on a church committee that decides how funds are allocated… in your personal life. Heck, give some cash to the bums on the freeway on and off ramps if you like.

    You simply have to treat everyone the same in your professional life, or you will only be disliked for it. People talk, and unequal treatment, favoritism, nepotism, etc etc are not traits anyone likes. It is a wedge you simply cannot allow to open the door. As you also alluded to, especially if you are in private practice, “like refers like,” and that doc who pays for some Rx for their patients will be the talk ’round the oil barrel campfire, the blackjack table, or whatever other savory locations your down-and-out patients like to congregate.

    …I work at a very large hospital with many staff and even more patients. I buy every employee on my unit the exact same small holiday gift (hell, I do the same with neighbors), whether they are a nobody whose name I’m not sure of or a RN guy I play basketball with weekly. I also set clear boundaries of only giving gifts to bona fide employees of the unit.. not residents or lab techs or PT or others who frequent it; you have to draw the lines and stick to them. I also attend none of the weddings or graduations or birthdays or retirement parties which I’m invited to by staff or patients (I simply explain that, to avoid favoritism, I must attend all or attend none… and I sure can’t attend all). They understand and I wish them well… and if they’re staff, I tell them I will probably see them at the next hospital-sponsored function.

    Being docs, we are all somewhat of workaholics, but you have to keep the sentiment and ideals of your personal life out of your professional space. I’ve wanted to offer a patient a ride when they sit in bus stop rains… or buy them coffee when I see them in the café, but you just cannot. It is business at the end of the day. Exceptions and “just this once” will just cause the problems to magnify for you in the future. That holiday house party you go to on invite from your secretary will turn into your PA resenting you when you can’t go to her kid’s wedding a few months later. If you must give gifts or things, frame it so that it is your nurses or assistants or whoever doing the patient a favor… that gets the effect and builds up the staff member, not you. It is best avoided altogether with standard and consistent and inflexible policies on everything, though. GL

    #179600 Reply
     ko 
    Participant
    Status: Other Professional
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    Joined: 02/03/2016

    I get the advice to keep professional and personal separate.

    That said, I also think there are exceptions and ways to help a human in need.

    If I were so inclined, I’d find a way to leave him some money anonymously so that there was no connection to you and/or possible expectation in the future.

    #179602 Reply
    MPMD MPMD 
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    Status: Physician
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    Joined: 05/01/2017
    Honestly I am most tempted not by the saddest cases but by things that would streamline dispo. Example a homeless pt w/ cellulitis who could be rx’ed w/ a $4 rx from Target but repeatedly states they won’t leave b/c they don’t have money to fill it. I have been tempted but haven’t given in. 

    Click to expand…

    These people quickly change my perception of them. If they say they won’t leave, I discharge them then call security to escort them out. I refuse to be taken hostage by patients like this.

    Click to expand…

    oh dude believe me my threshold to have difficult patients “helped” out the door is as low as anyone’s. i meant to say patients who seem to be genuinely saying they can’t afford a relatively cheap rx and are looking more for something like a med voucher. if they are being disruptive they get the old heave-ho in short order.

    #179615 Reply
    ENT Doc ENT Doc 
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    I would not, could not give them cash

    Not in my clinic, or for a rash

    Not for meds

    Or for some booze

    Not for gum

    Or nice new shoes

    There are other ways

    To lend a hand

    But no cash to patients

    My Pal, Anne  😉

    Click to expand…

    Looking for a new side hustle?

    Click to expand…

    Too many cooks in that kitchen.

    #179636 Reply
    portlandia portlandia 
    Participant
    Status: Physician
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    Joined: 07/07/2017

    I’m somewhat surprised and saddened by some of the answers so far, though it is understandable especially if giving money to patients is considered by institutions as “unprofessional behavior”, as in the linked article. Is this a commonplace corporate response to physician giving? Can one be fired for this? What would state medical boards say about physician giving? Would one’s license be at risk? What has happened to medicine? Where has the family doc and FRIEND gone to? Is being a physician supposed to entail only a “professional” and not a personal relationship? How are we supposed to have long term interactions with patients and not form deep attachments, that would move us from time to time to help in ways that are beyond a strict physician-patient interaction? How is giving money to someone in need “unprofessional?” Is that the kind of profession we want?

    Recently I had a patient with a dying family member in another state who could not afford to fly to see them. I struggled with the decision of whether to help (patient did not ask for my help) and if I could do it in an anonymous way and one that would not breach some ridiculous standard like the ones cited here. In the end, I dithered and the family member died and my patient and friend never got to say goodbye. Although I feel terrible about my decision, I guess I am supposed to feel like I did the right thing?

     

    #179645 Reply
    Liked by hatton1, Olórin, Anne, Tim
     IntensiveCareBear 
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    Status: Physician
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    …How are we supposed to have long term interactions with patients and not form deep attachments

     

    Click to expand…

    By that logic, I guess we should date or flirt with patients too. Hmmmm 🙂

    The answer to your question is by having (or seeking) the attachments, friendships, etc which you need in your personal life. You have two worlds, two personas, two sets of ethics, etc. That is the very core nature of professionalism.

    That professionalism concept will make it easy to set appropriate professional boundaries and deter you from looking for – or responding to – affection or attachment in your professional life. There is nothing wrong with empathy and building rapport with patients, but if you try to take on the world, do realize that the world can get pretty heavy. At the end of the day, they’re your health care clients. Nothing more, certainly nothing less. Don’t let it get personal… better for the patients and staff that way (Dr. Even Keel >>> Dr. Heart-on-Sleeve) and much better for you in that you can easily mentally decompress from work and enjoy your hobbies and pursuits once you leave the hospital for time off.

    It is a huge undertaking just to be a high functioning individual, add happiness and health to others, and lead by example in your professional life. It is even bigger to do all that and then have good fitness or social or family or community life in your personal time. You can’t fight other people’s battles for them (and they won’t learn anything if you did). GL

    #179648 Reply

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