Objective: This article reviews the issue of patients giving gifts to psychiatrists and mental health providers. Method: Anonymous survey of 100 academic psychiatrists measured prevalence of receiving gifts, type and estimated dollar value of gifts given, and psychiatrists’ reactions to gifts. Case vignettes illustrate clinical situations associated with gift giving and how failure to recognize motivation of gift giving may lead to situations requiring immediate intervention. Results: 71% of psychiatrists surveyed received (were offered & accepted) at least one gift in prior year (average 0.36 per month and 3.6 per year; $11.40 average [estimated] amount per gift). Group comparisons achieving at least a p < 0.05 significance: outpatient psychiatrists received gifts twice as often as inpatient, female and outpatient groups’ gifts were estimated as more expensive, a positive correlation was found between psychiatrists receiving gifts and psychiatrists giving a positive response to gifts, there was significantly more negative responses to high cost gifts (>$100) than to low cost (<$20), and outpatient psychiatrists reported interpreting gift’s meaning more often than inpatient. Conclusions: Psychiatrists are commonly offered and accept gifts from patients. Gifts communicate patient information and response to treatment. Although the act of gift giving sends important data to the receiving psychiatrist, including boundary violation issues, there are no agreed upon guidelines regarding how to respond. Future study should explore the meanings and appropriateness of a gift regarding type, cost, timing, frequency, intent, as well as how providers can respond to the gesture.
Boundary violation and sexual exploitation in psychiatry and psychotherapy: a review
