Unregulated gift giving between doctors and patients follows an old Bajan tradition

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There once was a time on this island when doctors did not drive BMW and Mercedes autos. There was a time when a doctor would go about his visits and stay for a meal, and perhaps receive nothing more than a meal because that was all there was. Several weeks later maybe a kingfish would be delivered to the doctor’s home and gratefully received because the doctor, like everyone, was struggling too. At Christmas time especially people would drop off what they could, and if a doctor’s son needed a better job, there was likely one to be found. If a tyre puncture needed attention as likely as not the doctor would return to the garage to find that someone had already taken care of the bill.

Those days are gone, but the gift giving has not gone. If anything the ‘gift giving’ between doctors and their patients has ramped up to impressive levels both in frequency and in the value of the bribes er, ‘gifts’ received by the doctors.

Why has this happened? Is it because the patients and citizens value the doctors and freely supplement the doctors’ salaries out of respect and thanks?

Perhaps…. but where do we divide the grateful gift givers from the subtle pressures by doctors that they could arrange that test a little earlier ‘if only the radiologist would be reasonable’ ???

We know how things work ’bout hey, and so does the Barbados Association of Medical Practitioners. That’s why the BAMP wants to address this ‘gift giving’ topic as soon as possible – because they say it has the potential to undermine the system with fraud and bribery.

The docs are right. Now, if we could only convince the politicians to do the same!

Please read the article Docs playing dirty at Barbados Today Online, but if it’s not there, we’ll have it here…

Docs playing dirty

by Emmanuel Joseph

The unregulated practice of gift-giving between doctors and patients in Barbados is creating fears of possible fraud and bribery in the minds of the hierarchy of the local medical representative body.

So worried are the administrators of the Barbados Association of Medical Practitioners, that the council is treating the issue as top priority and has signalled its intention to address it during the first week of January next year.

BAMP President Dr. Carlos Chase told Barbados TODAY that once the Christmas season was over, the council – the highest policy-making arm of the profession – would be tackling this controversial matter during the first week of the New Year.

The editorial of the latest BAMP Bulletin has attacked the practice head-on. It drew specific reference to instances where, as part of a paid radio broadcast, a doctor offered money to one group of individuals, while inviting others to attend a function in celebration of his birthday; and a second medical professional, was pictured presenting a gift of a refrigerator to a “double amputee”.

“The consequences of gift-giving and of framing potential actions as acts of giving, are far from benign and inconsequential. Rather, they may have profound effects on medicine and society,” said the printed mouthpiece of the medical association.

“Feelings of obligation are not related to the size of the initial gift or favour, rather, the rule of reciprocity imposes an obligation to repay for favours, gifts and invitations.”

The 12-member editorial committee, which includes the BAMP president, argued that whenever a gift or gesture of any size was bestowed, it imposed a sense of indebtedness.

“The issue of doctors receiving gifts from patients is quite a controversial issue with guidelines in other jurisdictions on limits of costs and types of gifts that may pose problems if accepted.

“On the other hand, and as a practical †matter, a doctor’s donation of gifts of nominal value should not create problems, but regulations offer little guidance as to what they would consider to be nominal.”

The medical profession executive observed that in some cases a gift may truly reflect an act of altruism, but in others, the giver may be expecting something in return.

The association said giving a gift may be a conscious or unconscious bribe and such giving to potential referral sources may create unintended consequences for practitioners and health care facilities alike.

“Practitioners should therefore not offer gifts as a way to reward past, or induce future referrals,” warned the doctors’ bargaining body.

BAMP is suggesting that consideration should be given to keeping gifts at a nominal value, not giving cash or its equivalent and not advertising the giveaways, in the absence of guidelines.

“In the absence of local guidelines,” noted the editorial, “where practitioners are unable to ascertain that either the gift is outside the realm of fraud and abuse, or that the gift fits within one of the regulatory exceptions; and whereas it is perhaps permissable to give inexpensive non-cash gifts, there should be some consideration for keeping the gift at a nominal value; for not giving cash or cash equivalents, that there be no advertisement of the giveaways.

“Above all, gift giving or remuneration that is likely to, or intended to influence the patient’s choice of provider, must be prohibited. BAMP’s council will address this issue as a high priority.” emmanueljoseph@barbadostoday.bb

15 Comments

Filed under Barbados, Consumer Issues, Corruption, Health

15 responses to “Unregulated gift giving between doctors and patients follows an old Bajan tradition

  1. Moneybrain

    I clearly remember my mother preparing one gallon of her very special Hotsauce for our Doc every year, those were the good old days!

  2. Well Well

    Yeah, well doctors these days like lawyers have upgraded themselves through greed, they want beemers and benz.

  3. Jrjrjrjr

    Too true ‘WellWell’ . I find most doctors and lawyers arrogant – all trying to bat above their station. Greed is a bad thing

  4. Robert Ross

    Moneybrain

    Yes, the “good old days”. What of giving little gifts to teachers as a sign of appreciation.Some university students do it still. “Here Sir……a mug from St Lucia.” Hardly the stuff of corruption. And yet……..

    Reading this post, it seems that the BAMP has the nuances about right. Doubtless, the issue turns on the value of the gift.

    I note the old faithfuls are now knocking doctors and lawyers. Well, at least it gives poor R a break.

  5. Well Well

    Don’t worry robert ross, we love Rihanna, does not mean we cannot voice our opinions, we are people not sheeple.

  6. Mark Fenty

    There was a time in Barbados when teachers used to induce learning,through the instrument of corporal punishment. Now, I think that it was quite justifiable for a teacher to utilize corporal-punishment, as a way to maintain some kind of order in the class -room. But, not to induce learning for those students who may have had a cognitive or intellectual impairment. Now what am I driving at here ?Will, with respect to the comment some made regarding a doctor in Barbados working for a bottle of hotsauce in time passed. Come on now, can we really see a doctor in modern day Barbados working for a bottle of hotsauce?

  7. Robert Ross

    Mark Fenty

    Are “inducing learning” and “maintaining order” the same thing and require the same methods?

  8. Robert Ross

    Well Well

    Good on ya….ur beginning to smile….though please…I don’t “love” R. Love unrequited is a terrible thing I know.

  9. Mark Fenty

    Robert, I hardly think that induce-learning through the medium of corporal-punishment, can be defined as same method of maintaining discipline in the class-room. You’ve offered lip-service thus far, but no evident to validate that there’re one of the same. Maybe I’ve failed to make myself heard in the clearest of terms, when trying to make this point. In any event, I was trying to make the comparison between the teaching- strategies once utilized during my time in school, and what we have come to learn in our present time.

    Now, some in contemporary pedagogy have argued that it was wrong to induce-learning through the method of corporal- punishment. Especially, to students who may have had some level intellectual and cognitive impairments. Moreover, there are studies which support the findings, that the use of corporal- punishment to induce learning has had a counterproductive effect. The social- scientists have founded during they research, that the use of corporal- punishment in the school or home environments encourage some level violence. And added to that scenario, it also causes some form of emotional and psychological baggage decades often the initial encounter.

    However, even though, sound data shows quite clearly that the use of corporal- punishment breeds an atmosphere of violence. I can’t help but to support this practice for the mere purpose of maintain order in the school environment. The Hebrew- Scriptures supports the use of corporal- punishment for the upbringing of the child, but for the mere purpose of instilling discipline in the child, and not to inducing academic learning. In any instance, this may come as a surprise to some people here, but in the United States of America, 19 states still supports the use of corporal- punishment to maintain order in the school environment.

    Consequently, my initial entry in the primary school system of Barbados was met with feelings insecurity, and rightful so, because the unbridgeable bond between the child and parent had been dissolved. However, after my first beating, I felt a pure dread at the thought of even returning to school the following day. Some teachers took the sadistic pleasure of beating students with the strap, bamboo, and the rulers for some of the most inconsequential things.

    Obviously, we must seriously ask ourselves the question, how was a child to empty his or her fears in those days. No where, because our parents didn’t want to hear it, and some teachers took pleasure in beating the shit out of us for the silliest of things. So what did students like me and others did, we internalized our feelings of resentment for the teachers that who were beating us, and our parents who were too ignorant to understand the differences. Now, flashback to 2012, all that I have described above is what we call child- abuse in our modern times Robert.

  10. Mark Fenty

    There once was a time on this island (listening to this stupidity) when doctors did not drive BMW’S and Mercedes automobiles. Of course not, we were still stuck in the donkey -cart days lol.

  11. Mark Fenty

    Give me a break sir, which time period are you referring to, 1985 or 1885?) Obviously, you haven’t the slightest idea how much it cost to attend medical school these days? So therefore, your great great grand-madda Kingfish can’t foot the bill today sir.

  12. Mark Fenty

    Now, don’t misconstrued what I am trying to convey here, because I’m quite cognizant of the fact that some doctors in Barbados played important behind scene role. By helping some of the poorest people in the community but this did not apply to everyone.

  13. Mark Fenty

    I haven’t as yet, heard no one making a sink about some members of the Royal Barbados Police Force, who has been taking bribes and kickbacks for decades. Why only single out the doctors who has and continues to make an important contribution the Barbadian society.

  14. Well Well

    Robert Ross, it depends on what u love her for and what u are praying she would love u for. Someday you may count your lucky stars that neither materializes, pardon the pun.