Written by Gina
A well-to-do cancer patient is nearing the end of her treatments. During an office visit, she says to her doctor, “I can’t thank you enough for the care you provided.”
Should the doctor simply accept the patient’s gratitude — or gently suggest a way for her to show it: “Perhaps you might consider making a donation?”
More and more these days, development offices at major cancer centers are teaching doctors to seize such opportunities to raise money for the medical center or for their own research.
In an unprecedented survey of more than 400 oncologists at 40 leading cancer centers, nearly half said they had been taught to identify wealthy patients who might be prospective donors. A third had been asked to directly solicit donations — and half of them refused. Three percent had been promised payments if a patient donated.
The study, which was published online Monday in The Journal of Clinical Oncology, was conducted by Dr. Reshma Jagsi, a radiation oncologist and ethicist at the University of Michigan, who had grown concerned about the practice and wanted to know more.
Dr. Jagsi said she had sat in on workshops, seminars, training sessions and department meetings that discussed how to identify good prospects for gifts, how to direct grateful patients to the development office, and how to ask them directly if they wanted to donate.
She was uncomfortable with the idea, but she also knew some patients want to donate and are grateful for guidance on how to do it. And she knew medical centers needed money now more than ever. What was the ethical way for doctors to help, she wondered? Or should they stay out of the donation business completely?
She searched the medical literature for studies on the subject and found pretty much nothing, so she decided to conduct her own research.
The issue is “extraordinarily important,” said Arthur L. Caplan, head of the division of medical ethics at NYU Langone Medical Center, adding that he had never seen a paper that examined the issues as thoroughly as Dr. Jagsi’s. “Hopefully, this paper will start a long overdue discussion,” he said.
He ticked off some ethical pitfalls: “Patients may be emotionally vulnerable; doctors have very close ties to their patients, which can strain asking on both sides; and the fact that incentives to ask sometimes skew toward the doctor’s own program rather than the most needy areas of the hospital.”
Yet, the practice of doctors soliciting donations from patients “is something that is happening and all signs are that it is going to continue and that it will increase,” said Dr. Joseph A. Carrese, a primary care doctor and bioethicist at Johns Hopkins.
Patient donations, he added, are “an important source of resources when money is tight.”
Dr. Carrese was concerned enough to join his colleagues in conducting an interview study of Hopkins doctors. He said he was reassured that the physicians recognized the ethical tightrope they were on. But some, he said, admitted to giving big donors special treatment.
“I’m more likely to arrange a special appointment time for those patients so we are not rushed,” one doctor who was interviewed for the study said. Another said, “I’m asking them to go above and beyond their relationship with me as a patient so I feel like I have to go above and beyond.”
Different medical centers have different policies. At the Harvard Dana-Farber Cancer Institute, the goal is to leave the doctor out of the equation, said the president and chief executive, Dr. Edward J. Benz Jr. If a patient asks how to donate, the doctor is supposed to direct the patient to the development office. At one point, administrators considered giving patients brochures on how to donate when their treatment ended, but then decided that would be inappropriate.
At the University of North Carolina, said Dr. Norman E. Sharpless, director of the Lineberger Comprehensive Cancer Center, oncologists are advised not to directly solicit patients but to notify a development officer when a patient seems able and willing to make a donation.
He explained how it often works: “A patient with financial capacity expresses an interest in helping. The doctor tells a development officer, who invites the patient and doctor to lunch. “When it comes time to discuss a donation, the doctor gets out of the way.”
Dr. Sharpless said he has never seen people get special care because they are rich, but added that there are subtle advantages that can accrue to donors. “If you are a prospective donor, or a donor, the development people can visit you at your home, can take you to lunch. If you are having a problem, your Rolodex at U.N.C. is bigger. You can reach out to the development officer and say, ‘I am having a problem.’”
For Tom and Nancy Chewning of Richmond, Va., the path to donation began when their daughter received what they considered extraordinary care at the Lineberger Center. On their own they made a generous gift in honor of their daughter’s oncologist, Lisa Carey. Then the development office asked if they might want to meet with Dr. Carey and discuss her needs.
So Mr. and Mrs. Chewning drove to Chapel Hill and sat down with Dr. Carey. When they asked what she needed, she said she could use money for her research and for helping patients, but she did not directly ask the Chewnings to contribute.
“I’m not very good at this,” Dr. Carey said. Then Mr. Chewning asked her if she thought they could make a difference with a donation. He and his wife went home and made an even more generous donation, 10 times the original amount.
“It is something that says, ‘I appreciate what you do,’ ” Mr. Chewning said. “I know it will be well spent.”
Jack Hyer and his wife, Laura Jensen, who live just outside Chapel Hill, both were treated for cancer at the University of North Carolina and were so grateful for the care they received that they reconsidered their initial impulse to donate money to the university for athletic scholarships. After meeting with the head of the cancer center they ended up allocating about $2 million for research and for an endowed professorship in radiology.
“We committed our entire estate,” Mr. Hyer said.
And Mr. Hyer made a training video for doctors to learn how to effectively ask for donations.
“The video sort of alerted them to be aware of the role they might play in identifying someone who might want to give,” Ms. Jensen said.
“They show that film regularly,” Mr. Hyer added.