Tips, status and sacrifice: gift giving in the doctor-patient relationship.

This study examines the gifts physicians receive from their patients. Internists in a hospital-based group practice kept diaries of gifts received and were interviewed about their responses and the reasons which they ascribed to the patient's gift-giving. It describes how physicians avoid reciprocating, categorizes the nature of gifts and, for the special instance of manipulative gifts, how these may be defused. Patient gifts are found to be reciprocations for some action on the part of the physician, which the patient, in turn, perceives as a gift. Three categories of gifts, according to their nature and timing, are: (1) gifts as 'tips', given to promote personalized service, to assure the continued interest and the tolerance of the physician; (2) gifts to address the status imbalance in the doctor-patient relationship, either by imposing a non-professional identity on the physician or by redeeming status lost in the sick role; (3) gifts as a sacrifice to the physician who exercises his power on the patient's behalf.