Gift-Giving in the Podiatric Medical Student–Patient Relationship

Abstract

We sought to explore the relationship between the podiatric medical student and the patient as it relates to the act of gift-giving as a sign of gratefulness for the services provided. This article presents the clinical case of a man who visited a podiatric medical student because of pain in his feet and subsequently presented the student with several gifts. Philanthropy, empathy, a positive attitude, treatment instructions, and the time devoted to the patient are some of the reasons why patients offer gifts to podiatric medical students. The relationship between the podiatric medical student and the patient and the act of gift-giving by patients are of ethical concern.

In the health-care system, personal gift-giving to students and professionals gives rise to ethical dilemmas as it influences the behavior of and relationship between both parties. [1] Generally, patients' motivation to offer gifts to physicians and students is connected to philanthropic and altruistic reasons, such as the desire to help or express gratitude. [2] However, other reasons for gift-giving may arise, such as the compensation of distinguishing and preferential attention or the patient's expectations based on the level of donations made. [3]

In any case, in our opinion, in a general sense, the student and the health-care professional should be prepared to understand these situations and to determine which of them violates their profession's code of ethics by influencing the behavior of and the relationship between both parties.

Podiatric physicians, as well as podiatric medical students, in most cases, received very scarce guidance and have little experience dealing with topics related to ethical dilemmas and patient philanthropy, among other issues. Therefore, it is necessary to study and provide guidance in this area with the aim of discussing and improving the relationship between both parties.

The lack of ethical guidelines and information about the relationship between students and patients in medicine [4] in general and in podiatric medicine in particular makes this report necessary, as it explores the relationship between a podiatric medical student and a patient regarding the act of gift-giving for the services provided.

Case Report

At an outpatient department of orthopedics and foot surgery, a podiatric medical student in his fourth year attended to a patient who had a previous appointment. At the first visit, the patient provided written authorization for health-care professionals to obtain his medical history and to proceed with the drafting of his clinical case following the ethical standards regarding experimenting on human beings relative to the Universal Declaration on Bioethics and Human Rights adopted by the by the General Conference of the United Nations Educational, Scientific, and Cultural Organisation on October 16, 2003.

The interview revealed that the patient was a white man aged approximately 50 years with no previous case of similar illness in his family, who requested to see a physician for long-term pain in the metatarsal area of both of his feet. The patient had been diagnosed as having metatarsalgia, and his previous medical treatments had failed.

The patient noted the lack of attention on the part of the physicians who attended to him on previous occasions. In addition, he recounted the lack of information provided about his pathologic condition and the very few recommendations he was given to improve his foot health.

Empathy and a positive attitude on the part of the podiatric medical student contributed to making the patient feel safe and confident from the very beginning and hopeful about his treatment. With this purpose in mind, custom orthopedic soles were developed that assist with posture stability, homogeneously distribute the pressure placed on both feet, and reduce the foot's impact when walking and standing.

In the following control and monitoring visits, the patient showed significant improvement; he reported feeling satisfied and very happy. In fact, he expressed his gratefulness to the student for helping him relieve his foot pain, which was preventing him from carrying out a normal and autonomous everyday life.

The patient was very satisfied and, on a 10-point analogical scale, he rated his experience a 10, deciding to offer a gift to the student as a sign of his gratitude for the attention provided, the positive attitude, the instructions concerning the treatment, and the time devoted, among other matters. The gift consisted of a series of foot anatomy and surgery books and tickets to a soccer game.

The podiatric medical student was very satisfied with the patient's evolution, and he accepted his gifts, showing his gratitude and insisting that it was not necessary, as he believes it is a real pleasure to help improve people's health.

Discussion

The increasing biomedical advances, the complexities inherent in podiatric medical activity, and financial and workload pressures have brought about a growing demand for the podiatric physician, who frequently experiences the requirements related to medical problems, as well as the priority given to ethical dilemmas in podiatry. These subjects have become an intrinsic component of clinical practice, [5,6] as is the case of gift-giving by patients.

The scarcity of ethical guidelines published for these kinds of situations makes it necessary to explore the relationship between podiatric medical students and patients as it relates to gift-giving as a sign of gratitude for the services provided. Some patients tell medical students about matters that they hardly ever reveal to physicians, and this has to do with empathy, the difference in age between the patient and the student, the student's innocence and ingenuousness (which is interpreted as endearing), and the extra time that medical students can use to have the luxury of spending time with the patient to improve attention, [7] as illustrated in the present clinical case.

The gratitude shown by patients is associated with the reward to the students or doctors for their dedication and attention after their consultation times, for their preferential treatment, and for their capacity to recognize the illness and its cure. These aspects are all objects of philanthropic study, which assumes that one of the parties freely gives to the other in a way that both may attain a mutual and equitable benefit. [8]

Thus, the nature of the donations and the decision to accept or reject the presents should be governed by moral autonomy and by the orientation offered by professional guidelines and codes of ethics, where gift-giving is established as a culturally valid response, especially when it consists of “small” presents, [9] which entail a philanthropic and altruistic relationship and a wish to help or express gratitude.

Conclusions

In this case report, we describe the relationship between the podiatric medical student and the patient as it relates to the act of gift-giving involved in grateful patient philanthropy and the ethical concerns related to this activity. Further studies could examine how best to prepare podiatric medical students for the challenges that may accompany these gifts in exchange for podiatric medical attention so as to help them maintain the expected professional and ethical standards when accepting grateful patient philanthropy.

Financial Disclosure: None reported.

Conflict of Interest: None reported.