Perhaps the most unusual gift I’ve been given by a patient came when I worked part-time at a rural practice in deepest Norfolk while studying for an MA at the University of East Anglia. The patient in question was a long-retired farm labourer whom I helped through a nasty pneumonia. He wasn’t well-off, but at some point in life he had mastered the art of knitting string dishcloths, and he presented me with one as a token of his gratitude. It was more hole than string, but I kept it for several years, so touched was I by the gesture.
During that year, I lived in the village where the practice was located, and it didn’t take long for people to learn where the new doctor’s house was. From time to time I would arrive home to find a carrier bag dangling from the door handle containing half a dozen free-range eggs, or a crop of runner beans, or some other anonymous donation of home produce. This was the mid-1990s, but it was a taste of what life must have been like for country doctors a generation or two before.
The General Medical Council has strict rules on accepting gifts from patients. Great care must be taken to avoid any abuse of trust, and the doctor must ensure that presents don’t – or aren’t perceived to – affect the treatment a patient is given. A few years ago, back on my home turf in the south-west of England, I looked after a somewhat belligerent businessman who had a non-serious but irksome bowel complaint. Frustrated by his ongoing symptoms, he came seeking a specialist referral; he also wanted me to get on the phone and sort it out urgently for him. These requests were made while presenting me with a bottle of extremely fine and extremely expensive wine. I thanked him very much, but explained I had to refuse the gift and assured him that I would care for him exactly as I would anyone else with the same problems.
Easily my most ill-advised acceptance of an unexpected present was when a retired Anglican clergyman registered as a patient about five years ago. In the course of our first consultation, I discovered his lifelong involvement in academic theological debate, and was interested to learn that since retiring he’d published two books. I should have known better as a writer myself, but evidently I let myself appear just a little too interested. A couple of days later a parcel appeared in my in-tray containing copies of both esoteric, weighty tomes, with a handwritten note saying he looked forward to hearing my thoughts. Our subsequent consultations were attended by ever-increasing awkwardness as, again and again, I failed to make any comment about them. I found them on my shelves just recently – still unread – when decluttering my room. It made me realise that, at some point in the intervening years, he had simply given up and registered elsewhere, perhaps hoping to find a doctor with more time on his hands for extracurricular advancement.
Under the terms of the contract with the NHS, GPs must maintain a register of any gifts worth more than £100. From time to time in my practice we are left bequests, or a deceased patient’s family will ask mourners to make donations to the surgery rather than buying funeral flowers. We pay these monies into a separate amenity account, and use the funds to enhance patient care.
Christmas, of course, is a time for giving, and from early December gifts start to come in from patients. There’s always a thumping cake from Mrs Fox, which we hoist to the staff room upstairs and by great collective effort manage to whittle down to a few crumbs and stray raisins over the coming weeks. Other presents come in bottles or boxes – booze, biscuits or chocolates.
My senior partner, Hugh, gets more than the rest of us put together. In part this reflects his length of service: he was one of the two co-founders of the practice, and has been in post nigh-on 30 years, during which time he’s helped a heck of a lot of people. He also has a wonderful bedside manner. He is deeply interested in people, and frequently spends more time in the consultation catching up on what they’ve been doing, how their family is getting on, where the new house is, and what happened to the dog, than he does in talking about their medical problems.
As a consequence, Hugh is pretty much the essence of all that is good in British general practice. I’ve lost count of the times one of us has been discussing a perplexing patient over coffee, only for Hugh to fill us in on the key bit of information about whom they’re related to, or what happened to them in the distant past, which suddenly solves the puzzle.
We’d have lost him years ago if we let him eat and drink everything he’s given at Christmas. Instead, everyone’s presents are stacked in the practice manager’s office – in effect, a Santa’s grotto – and in the days leading up to the holiday each staff member is invited to take a share. It’s recognition that our practice is only as good as the loyal and dedicated people – receptionists, administrators, nurses, cleaners – who make up our wonderful team.