Doctors commonly receive gifts of alcohol in professional settings, particularly after giving a talk. This article reflects our personal opinions of this practice. We want our colleagues to consider the symbolism of giving or receiving alcohol as a gift in a professional setting. This is not a promotion of abstinence.
Doctors should be aware of the preventable death and suffering caused by the harmful consumption of alcohol. Thirty per cent of emergency department attendances are alcohol related,1 and there are also personal health risks, mental health issues and social issues involved. Balanced against this, the health benefits of drinking alcohol are not clearly established.2 There is little to be said in favour of the promotion of alcohol, but consumption is a personal choice. In contrast, gift giving of alcohol in professional settings is a public statement.
Many professional bodies have policies on alcohol consumption, but we could find none — including the websites of the Royal Australasian College of Physicians, Royal Australasian College of Surgeons, and Royal Australian College of General Practitioners — with policies on giving alcohol as gifts. Health care professionals have a duty to promote health; as individuals and in our professional groups. The provision of alcohol as a gift would seem to be contrary to a basic tenet of medical practice, which is to promote health.
Alcohol consumption is an accepted part of Australian culture. Our impression is that no one has questioned the appropriateness of alcohol as a gift in the health professional setting. “Everyone drinks (alcohol)” is a frequently used phrase. This is not true as 20% of Australians do not consume alcohol.3 Therefore, the recipient of the alcohol gift could be pregnant, a recovering alcoholic or from a cultural or religious tradition that prohibits alcohol consumption. Others just do not consume alcohol. Giving alcohol as a gift in a professional setting is an ingrained habit, with little thought given to the choice of gift, consideration of the recipient or symbolic consequences of the act.
There are alternatives to giving alcohol as a gift. Giving a gift to someone who has taken the time to prepare and give a talk cannot compensate him or her adequately for his or her time, but it is a token of appreciation. So some thought on the part of the gift giver is in order. International speakers could have something from the country they are visiting and, similarly, someone from interstate could receive something particular to that state. If something particular cannot be identified, general gifts might include chocolates or flowers. Book or music vouchers are always valued. There are also charities that provide online gifts.
In summary, gift giving of alcohol in a professional setting is inappropriate in that it may be insensitive to the recipient and is a poor health promotion message. We call for professional health bodies to take a leadership role and develop policies to find appropriate alternatives to giving alcohol as a gift. We challenge health professionals to be more thoughtful in their choice of gifts in a professional setting.
Received 31 July 2015, accepted 23 October 2015
- R John H Massie1
- A Rob Moodie2
- 1 Royal Children's Hospital Melbourne, Melbourne, VIC
- 2 University of Melbourne, Melbourne, VIC
- 3 University of Malawi, Blantyre, Malawi
No relevant disclosures.
- 1. Egerton-Warburton D, Gosbell A, Wadsworth A, et al. Survey of alcohol-related presentations to Australasian emergency departments. Med J Aust 2014; 201: 584-587. <MJA full text>
- 2. Knott CS, Coombs N, Stamatakis E, et al. All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ 2015; 350: h384.
- 3. Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report 2013. Canberra: AIHW. (AIHW Cat No. PHE 183; Drug Statistics Series No. 28.) www.aihw.gov.au/publication-detail/?id=60129549469 (accessed Oct 2015).
Adrian Pokorny
The power and influence of any gift relates in large part to the context of its provision and from whom it is obtained. For example, a bottle of vintage Grange given by a pharmaceutical representative to commemorate a new drug has very different connotations to a more modest beverage offered in thanks by the family of a recently deceased patient. The former would be ethically dubious, while the latter would not.
Rather than concentrating on the specific ills of alcohol, it may be more prudent to clarify when gifts per se are deemed ethically acceptable. It has long been established that receiving presents, regardless of their value, can create a sense of reciprocity between the giver and the recipient.[2,3] Where there may be a conflict of interest, such as with a pharmaceutical representative, this is highly problematic. When there is no conceivable further benefit to the giver, such as after the death of a patient, this is likely to be less troublesome, particularly when the gift is of negligible monetary value.
It is perhaps the case that professional bodies should in general have better clarification around the role of gifts in the profession. This should include, but not be limited to, alcohol. All gifts have unenviable attributes, associated more with the nature of the act rather than the gift itself. It is this that requires more guidance, rather than the perceived public health message of receiving alcoholic beverages.
[1] Massie RJH and Moodie AR. Alcohol gifts in medicine. Med J Aust 2015;203(11):436.
[2] Cialdini RB and Goldstein NJ. Social influence: compliance and conformity. Annu Rev Psychol 2004;55:591–621.
[3] Katz DA, Caplan AL and Merz JF. All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift-giving. Am J Bioeth 2003;3:39–46.
Competing Interests: No relevant disclosures
Dr Adrian Pokorny
The University of Sydney, Australia
Robert GordonBatey
All we will have to hold onto will be the perfectly accurate, fully detailed, politically correct, emotionally neutral documents produced by our risk averse leaders. Small comfort. Not really human.
Competing Interests: No relevant disclosures
Dr Robert GordonBatey
John Hunter Hospital
John EvelynThompson
Competing Interests: No relevant disclosures
Dr John EvelynThompson
retired