by Emmanuel Joseph
The unregulated practice of gift-giving between doctors and patients in Barbados is creating fears of possible fraud and bribery in the minds of the hierarchy of the local medical representative body.
So worried are the administrators of the Barbados Association of Medical Practitioners, that the council is treating the issue as top priority and has signalled its intention to address it during the first week of January next year.
BAMP President Dr. Carlos Chase told Barbados TODAY that once the Christmas season was over, the council – the highest policy-making arm of the profession – would be tackling this controversial matter during the first week of the New Year.
The editorial of the latest BAMP Bulletin has attacked the practice head-on. It drew specific reference to instances where, as part of a paid radio broadcast, a doctor offered money to one group of individuals, while inviting others to attend a function in celebration of his birthday; and a second medical professional, was pictured presenting a gift of a refrigerator to a “double amputee”.
“The consequences of gift-giving and of framing potential actions as acts of giving, are far from benign and inconsequential. Rather, they may have profound effects on medicine and society,” said the printed mouthpiece of the medical association.
“Feelings of obligation are not related to the size of the initial gift or favour, rather, the rule of reciprocity imposes an obligation to repay for favours, gifts and invitations.”
The 12-member editorial committee, which includes the BAMP president, argued that whenever a gift or gesture of any size was bestowed, it imposed a sense of indebtedness.
“The issue of doctors receiving gifts from patients is quite a controversial issue with guidelines in other jurisdictions on limits of costs and types of gifts that may pose problems if accepted.
“On the other hand, and as a practical †matter, a doctor’s donation of gifts of nominal value should not create problems, but regulations offer little guidance as to what they would consider to be nominal.”
The medical profession executive observed that in some cases a gift may truly reflect an act of altruism, but in others, the giver may be expecting something in return.
The association said giving a gift may be a conscious or unconscious bribe and such giving to potential referral sources may create unintended consequences for practitioners and health care facilities alike.
“Practitioners should therefore not offer gifts as a way to reward past, or induce future referrals,” warned the doctors’ bargaining body.
BAMP is suggesting that consideration should be given to keeping gifts at a nominal value, not giving cash or its equivalent and not advertising the giveaways, in the absence of guidelines.
“In the absence of local guidelines,” noted the editorial, “where practitioners are unable to ascertain that either the gift is outside the realm of fraud and abuse, or that the gift fits within one of the regulatory exceptions; and whereas it is perhaps permissable to give inexpensive non-cash gifts, there should be some consideration for keeping the gift at a nominal value; for not giving cash or cash equivalents, that there be no advertisement of the giveaways.
“Above all, gift giving or remuneration that is likely to, or intended to influence the patient’s choice of provider, must be prohibited. BAMP’s council will address this issue as a high priority.” firstname.lastname@example.org