In Reply: Many thanks to Dr. Epstein for her comments, which are both gratifying and illuminating. Her observation that there is no blanket rule for such issues is particularly to the point. We are often discouraged from making gifts to patients; further, we are often discouraged from discussing the subject. In breaking this taboo, it was my hope to stimulate discussion of this important issue. I suspect that most clinicians have struggled with the question of whether presenting a gift is appropriate. Surely, Dr. Epstein and I are not alone.
Dr. Epstein's comments also suggest another tantalizing question: could we use gifts for therapeutic purposes? It seems that we might; however, she is correct in noting that there must be specific, well-thought-out reasons for doing so. Certainly seeking consultation or supervision from a colleague is one way to guard against inappropriate behavior.