Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

The Do’s and Don’ts of Discussing Monetary Donations With Patients

"Crassula ovata," the jade plant, is a succulent that traditionally represents monetary prosperity.


Unless patients initiate the discussion about philanthropy, it’s wise to be cautious on this topic. Such practices will preserve a trusting patient-clinician relationship.

Our recent article published in JAMA reported on the attitudes of the public regarding practices that hospitals and clinics are engaged in with respect to generating donations from grateful patients. This was the first study to examine how members of the public think about these issues and the findings were very interesting. The bottom line is that many of the practices currently utilized aren’t supported by the public, including the following: doctors giving the names of patients to fundraising staff without the first getting the patient’s permission; clinicians initiating discussions about the topic of donations before patients bring it up; fundraising staff using publicly available data to conduct wealth screening to identify patients who might be able to make large donations; and practices intended to express appreciation to patients who do donate, including expedited clinic appointments and access to physician cell phone numbers. One major concern expressed by a vast majority of survey respondents is that clinician involvement in these activities could interfere with the doctor-patient relationship.


Were these findings surprising? Not entirely. Concerns about the impact on the clinician-patient relationship have been noted in past reports. But, this is the first time we’ve heard these concerns expressed by members of the public. Should we change what’s being done in response to the findings of this study? This is a critical question that must be carefully considered by development professionals, physicians, and institutional leaders. The findings suggest that some adjustments should be made in the way we’re doing business so that we conduct ourselves in ways that are aligned with public opinion about what’s ethically appropriate with respect to patient fundraising practices. To the extent that we get this wrong, risks include damaging the clinician-patient relationship and the patient-institution relationship. That could lead to undermining the public trust and public support more generally; and ultimately, perhaps ironically, to less success in raising philanthropic dollars.


How important is philanthropy to hospitals and academic institutions anyway? Grateful patient philanthropy is extremely important to many, if not most, hospitals and academic medical centers. As the JAMA paper states at the very beginning, grateful patient philanthropy has become an increasingly important source of revenue for all healthcare institutions, but especially academic healthcare institutions as other streams of revenue are decreasing, whether it’s federal support for research or revenue generated by clinical activities. So to address all parts of the mission, including research, education, and clinical care, philanthropic dollars are needed. The challenge is to, on the one hand, recognize that fact and honor the willingness of some patients to be generous and facilitate their giving, but, at the same time, do so in a way that is ethically acceptable—to the public as well as healthcare institutions and healthcare professionals.


What can you do about this issue? I suggest the following:


1. Make sure you have your priorities in order. First on the list is having trusting relationships with your patients.


2. Be prepared to respond to a patient’s interest in making a gift if they initiate a conversation about it.

A valuable resource is your institution’s development professional, who can provide helpful guidance if a patient expresses interest in supporting your work or the institution more broadly.


3. Be cautious about bringing up the topic of donating money unless and until patients themselves initiate the conversation—we know that otherwise some patients will be offended.


4. Hold your institution accountable for their practices, especially the ones we’ve learned the public doesn’t approve of—start a dialogue with colleagues and institutional leaders to address these issues.