None of us expect a gift, none of us need them, but we do appreciate them.

A T-Shirt.

That was the very first present I ever had from a patient. I am embarrassed to say I can't remember what I did that was different or special in any way, but I do remember her. She was a lovely lady who I remember as always being very well dressed on the ward. At a time when most people stayed in their pyjamas, she didn't. I loved it and wore it regularly.

A 15cm ruler.

Bought for me by a patient who I looked after for years. She had a mediastinal mass that we were monitoring. In the days before electronic X Ray imaging this meant she would come to my appointment via X Ray with the physical image in her hands. We would put it up on the light box and measure the very visible, calcifying mediastinal mass. After a few months of watching me scrabble around for something to measure it with, she brought me a ruler. Finally we had some consistency. I still have that ruler, twenty years later, in my top drawer. I kept in touch with her for many years.

A fountain pen.

From the parents of a teenager with an illness from which he did not recover. That pen sits in my top drawer too. I still think of him.

A leather cowboy hat.

From a man who was filled with wit and charm through a chronic illness. He always carried a “sparklewood” cane, a piece of art that went everywhere with him. It was a twisted, carved, shiny mahogany beauty and it was solid. The hat didn't fit but of course I still have it.

Another fountain pen.

From a patient who was cured of cancer during pregnancy. When I look back to the intense time of her illness, what I remember is the strangeness of discharging her from follow up several few years later when she had a toddler with her.

A fake Mont Blanc pen from summer travels in Dubai.

She told me it was fake, it would not write and it ripped the page if you tried, but it looked the part. I went on to know her for years, she always made me laugh.

Champagne from a couple.

Too recent to describe them or the issue, but a couple I aspire to be like in my retirement.

In the next few weeks we may all get something from a patient, probably chocolate more than anything else. But what would you do if it was a really over the top present?

Unfortunately gifts can cause a moral and ethical dilemma. Is it too much? Is it too generous? What would this look like to someone else or the patient’s family? There is plenty of advice from the BMA, your defence union, the GMC or your employer about handling gifts. We should never ask for them, and they should never influence our decision making in any way. The Medical Defence Union sum it up well:

“Accepting gifts from patients is not forbidden, but doctors should be careful as to what they accept and how this is recorded”

If you need some specific advice and guidance, look at Page 9 of the GMC’s guide on managing conflicts of interest, or speak to your employer. This might help a few of you with unexpectedly generous gifts at this time of year. I have seen policies come and go over the years, trying to work out what value of gift is too much. It seems to vary from £25 to £50. Inflation helps show the age of any policy you manage to find.

I do remember a long-retired colleague who always told me though, “beware of patients bearing gifts”. What I have come to learn from that is just to think when you get one. Has the gift come at an odd time, like the first time you meet someone? Is it too much, too valuable or inappropriate? Am I being manipulated or unduly influenced here? I think this would be very rare, but it is always possible. How you handle that situation would require particular sensitivity - don't be afraid to get advice.

The gifts I have described above were all from people I knew well at the time. They were all a simple “Thank you”. That's my internal “ok” message, a clear thank you for something done, no sense of obligation and perfectly easy to explain.

It is just as nice to receive a thank you card with a letter inside too. I keep all of those (in that top drawer). Sometimes the most thoughtful gifts, like the ruler, are the ones that mean the most. They are personal and reflect the relationship you had with someone in a way that only the two of you really understand.

My colleague was given a stapler last week. Beat that.