The gift triggers a human instinct to reciprocate; even if the reciprocation involves nothing more than giving the detail person a few moments of your time.  It may be entirely reasonable to accept a small token of appreciation from a patient. In fact, refusing it may cause embarrassment that could unnecessarily harm the relationship between a doctor and a patient. Doctors should try to understand the reasons behind a patient’s gift. Doctors should never accept a gift if there is any risk that it may influence their professional decision making. Physicians should also take into account factors such as the cost of the gift in proportion to the patient’s means, the appropriateness of the gift, and whether there are particular circumstances, such as the patient being vulnerable, that may attract criticism. Transparency and accountability are essential when considering an offer of a gift from a patient. Doctors should keep a record of any gifts they receive for their appraisal and revalidation. Patients should donate money to the hospital charity rather than to an individual. A ‘thank you,’ a letter recounting the family’s joy, or a photo of the patient enjoying a moment of life that medical care allowed him to experience. Patients should donate cash gifts that they have received from patients to charity or buy practice equipment that will benefit patients.