Take two pills and make a donation

I was a resident, on morning rounds. The attending neurologist was young and ambitious (weren’t we all once?), trying to get the hospital to help him fund a research program in his subspecialty of interest.

One of the patients we saw that morning was a locally known successful businessman who’d been admitted, fortunately not for anything too serious.

My attending took the history, verifying the one I’d presented, and examined the gentleman. He then made some teaching points and explained the care plan to the patient.

Pretty standard up to that point.

After answering questions, however, the attending suddenly went into a sales pitch on his new research program, asking the guy for a financial donation, and giving him the card for the person at his office handling the funding.

I don’t remember anymore if he repeated that with other patients, but even now it still leaves a bad taste in my mouth. As a resident I wasn’t in a position to criticize him, nor did I want to endanger my own standing in the program by talking to someone higher up.

He was, fortunately, the only attending I ever worked with who did that. It still stands out in my mind, perhaps as an example of what not to do, and sometimes I still think about it.

Perhaps I’m naive, but I assumed he was an aberration. Apparently not, as the American College of Physicians recently issued a position paper advising its members not to ask patients for donations to the doctor’s workplace. There’s actually an acronym, GPF (Grateful Patient Fundraising) for this.

I understand a lot of these doctors are in academics and need funding for research and other programs. I know that a lot of good comes from this research, and I fully support it.

But this seems to be a bad way of doing it. Standing at the bedside on that long-ago morning, I remember thinking the patient (who looked kind of surprised) was going to wonder if this was a vague sort of hint: You’ll get better care if you pay up. Or a veiled threat that you may not get decent care if you don’t. I have no idea if he donated.

There must be a better way to get funding than hitting up a patient as part of the care plan. Perhaps discharge materials might include a brochure about how to make a donation, if interested. Or the ubiquitous portal might have a “donate” box in the task bar.

If the patient were to initiate this on his own, I wouldn’t have an issue with it. He gets out of the hospital, is grateful for his care, and calls the physician’s office to say he’d like to make a donation to whatever his program is (or just goes online to do it). That’s fine. I’ve even had the occasional patient call my office to say they’d like to make a donation to my favorite charity, and I give them a list of various neurology research foundations (none of which I’m affiliated with, for the record).

But to actively solicit donations from someone under your care is tasteless and inappropriate. It creates a conflict of interest for both parties.

The patient may believe he’ll get better care, and is obligated to keep giving – or else. The physician may feel like he’s stuck going beyond what’s really needed, ordering unnecessary tests and such to keep the financial VIP happy. And what happens if the big donor patient calls in because he hurt his ankle and needs a Percocet refill that another doctor won’t give him?

The statement by the ACP is appropriate. The only thing that bothers me about it is that it had to be made at all.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I was a resident, on morning rounds. The attending neurologist was young and ambitious (weren’t we all once?), trying to get the hospital to help him fund a research program in his subspecialty of interest.

One of the patients we saw that morning was a locally known successful businessman who’d been admitted, fortunately not for anything too serious.

My attending took the history, verifying the one I’d presented, and examined the gentleman. He then made some teaching points and explained the care plan to the patient.

Pretty standard up to that point.

After answering questions, however, the attending suddenly went into a sales pitch on his new research program, asking the guy for a financial donation, and giving him the card for the person at his office handling the funding.

I don’t remember anymore if he repeated that with other patients, but even now it still leaves a bad taste in my mouth. As a resident I wasn’t in a position to criticize him, nor did I want to endanger my own standing in the program by talking to someone higher up.

He was, fortunately, the only attending I ever worked with who did that. It still stands out in my mind, perhaps as an example of what not to do, and sometimes I still think about it.

Perhaps I’m naive, but I assumed he was an aberration. Apparently not, as the American College of Physicians recently issued a position paper advising its members not to ask patients for donations to the doctor’s workplace. There’s actually an acronym, GPF (Grateful Patient Fundraising) for this.

I understand a lot of these doctors are in academics and need funding for research and other programs. I know that a lot of good comes from this research, and I fully support it.

But this seems to be a bad way of doing it. Standing at the bedside on that long-ago morning, I remember thinking the patient (who looked kind of surprised) was going to wonder if this was a vague sort of hint: You’ll get better care if you pay up. Or a veiled threat that you may not get decent care if you don’t. I have no idea if he donated.

There must be a better way to get funding than hitting up a patient as part of the care plan. Perhaps discharge materials might include a brochure about how to make a donation, if interested. Or the ubiquitous portal might have a “donate” box in the task bar.

If the patient were to initiate this on his own, I wouldn’t have an issue with it. He gets out of the hospital, is grateful for his care, and calls the physician’s office to say he’d like to make a donation to whatever his program is (or just goes online to do it). That’s fine. I’ve even had the occasional patient call my office to say they’d like to make a donation to my favorite charity, and I give them a list of various neurology research foundations (none of which I’m affiliated with, for the record).

But to actively solicit donations from someone under your care is tasteless and inappropriate. It creates a conflict of interest for both parties.

The patient may believe he’ll get better care, and is obligated to keep giving – or else. The physician may feel like he’s stuck going beyond what’s really needed, ordering unnecessary tests and such to keep the financial VIP happy. And what happens if the big donor patient calls in because he hurt his ankle and needs a Percocet refill that another doctor won’t give him?

The statement by the ACP is appropriate. The only thing that bothers me about it is that it had to be made at all.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I was a resident, on morning rounds. The attending neurologist was young and ambitious (weren’t we all once?), trying to get the hospital to help him fund a research program in his subspecialty of interest.

One of the patients we saw that morning was a locally known successful businessman who’d been admitted, fortunately not for anything too serious.

My attending took the history, verifying the one I’d presented, and examined the gentleman. He then made some teaching points and explained the care plan to the patient.

Pretty standard up to that point.

After answering questions, however, the attending suddenly went into a sales pitch on his new research program, asking the guy for a financial donation, and giving him the card for the person at his office handling the funding.

I don’t remember anymore if he repeated that with other patients, but even now it still leaves a bad taste in my mouth. As a resident I wasn’t in a position to criticize him, nor did I want to endanger my own standing in the program by talking to someone higher up.

He was, fortunately, the only attending I ever worked with who did that. It still stands out in my mind, perhaps as an example of what not to do, and sometimes I still think about it.

Perhaps I’m naive, but I assumed he was an aberration. Apparently not, as the American College of Physicians recently issued a position paper advising its members not to ask patients for donations to the doctor’s workplace. There’s actually an acronym, GPF (Grateful Patient Fundraising) for this.

I understand a lot of these doctors are in academics and need funding for research and other programs. I know that a lot of good comes from this research, and I fully support it.

But this seems to be a bad way of doing it. Standing at the bedside on that long-ago morning, I remember thinking the patient (who looked kind of surprised) was going to wonder if this was a vague sort of hint: You’ll get better care if you pay up. Or a veiled threat that you may not get decent care if you don’t. I have no idea if he donated.

There must be a better way to get funding than hitting up a patient as part of the care plan. Perhaps discharge materials might include a brochure about how to make a donation, if interested. Or the ubiquitous portal might have a “donate” box in the task bar.

If the patient were to initiate this on his own, I wouldn’t have an issue with it. He gets out of the hospital, is grateful for his care, and calls the physician’s office to say he’d like to make a donation to whatever his program is (or just goes online to do it). That’s fine. I’ve even had the occasional patient call my office to say they’d like to make a donation to my favorite charity, and I give them a list of various neurology research foundations (none of which I’m affiliated with, for the record).

But to actively solicit donations from someone under your care is tasteless and inappropriate. It creates a conflict of interest for both parties.

The patient may believe he’ll get better care, and is obligated to keep giving – or else. The physician may feel like he’s stuck going beyond what’s really needed, ordering unnecessary tests and such to keep the financial VIP happy. And what happens if the big donor patient calls in because he hurt his ankle and needs a Percocet refill that another doctor won’t give him?

The statement by the ACP is appropriate. The only thing that bothers me about it is that it had to be made at all.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.