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To accept or not to accept?

The scenario

It’s the beginning of December and one of your clients approaches you and says that they would like to give you a little something to thank you for your work. You politely tell the client that while you are flattered, you cannot accept gifts. You explain that accepting gifts is against the standards set by the profession. You also explain that the exchange of gifts between professionals and their patients/clients can blur the lines of the professional relationship. At your final appointment with this client before you break for the holidays, they hand you an envelope. You open it up and see a card and $20 in cash. What do you do?

Questions to consider

Is this a legal issue or an ethical issue?

This is an ethical issue. Honesty and integrity are fundamental to the delivery of professional services. As stated in the Practice Standard- Professional Boundaries, the professional relationship is based on respect, trust and professional competence. You are responsible for setting and managing boundaries. One of the ways you establish boundaries and confirm the professional relationship is by refraining from accepting and giving gifts.

What are the differences in power?

There is always going to be an inherent difference in power between you and your patients/clients. You have specialized skills, knowledge and access to personal health information. They rely on your professional judgment and recommendations.

What would happen if you accepted the gift?

By accepting the gift you are violating the standards set by the profession. If discovered that you accepted a monetary gift from a patient/client, you could become the subject of an investigation for professional misconduct, and possibly a Discipline hearing. It may not be a patient/client who reports you, but another kinesiologist or health professional who becomes aware that you crossed a boundary.

What should you do?

The simplest solution is to politely decline and return the money to the client. Ask them to donate the money to charity and assure them that the professional relationship will not change. Maintain a professional rapport and explain why you are declining the gift to ease the feeling of rejection.

In future, consider informing your patients/clients early on that you cannot accept gifts beyond a nominal value. Let them know that accepting gifts can cloud boundaries and may be seen as influencing the care/services you provide. For example, patients/clients may feel that by giving you a gift, they can receive preferential service. Or patients/clients who witness the exchange may think that this is how they receive preferential service.

Speak to a mentor or peer about the situation. On the College website you can access the practice standards to help you understand expectations around maintaining appropriate boundaries. Have physical copies of these documents on hand to show patients/clients if they keep insisting on giving you a gift. You may even contact the College or your professional association if you need further assistance.

Conclusion

While patients/clients may try to show their appreciation for your hard work through gift giving, it is important to be vigilant and mindful by sensitively, but firmly, educating them about the nature of the professional relationship. By doing so, you are protecting vulnerable clients from potential abuse, yourself from potential complaints, and upholding the integrity of the profession.