Targeting Patients for Donations: Opening a Door, or Pushing Them through It?

Abstract

Targeting Patients for Donations: Opening a Door, or Pushing Them through It? Michelle A. Burack I was in the clinic hallway with my patient en route from the waiting room to the exam room for a routine follow-up appointment. I said, “Thank you again, so much, for your donation to the department in my honor.” “Sure, no problem,” my patient replied. “Although I have to say, when I first opened the letter, it was kinda creepy. But I’m so grateful for your excellent care, that I felt like I had to send something.” I stopped in my tracks. “Wait—the hospital sent you something asking for a donation?” I had been practicing at an academic medical center as a neurologist specializing in movement disorders for six years. I was at the awkward Assistant Professor level, feeling confident in the excellence of my clinical skill but still very junior in the power hierarchy. I chose movement disorders as a subspecialty in part because of the long-term relationships we develop with our patients. Conditions like Parkinson’s disease and dystonia are managed, not cured. During training, I looked forward to having the sacred responsibility of following “my” patients over the long course of their disease trajectory. We typically see people every three months for many years. It is a specialty that allows us, in the words of Hippocrates, “to know what sort of person has a disease,” not simply “to know what sort of disease a person has.” Skillful use of available treatments requires attention to nuance: not only the subtle details of how the brain is controlling movement during everyday activities like writing, reaching, and walking, but also aspects of behavior arising from circuits in the brain governing mood, decision-making, and interpersonal relationships. Trust is essential for cultivating the close doctor-patient relationships that I rely on to identify how these diseases and treatments impact domains of brain function that are intimately linked to personhood. After the appointment, I sent an email to the advancement office. “Can you please clarify—are our patients being targeted for donations?” I was informed that legislation passed the previous year made it possible for the advancement office to view the provider’s name and department associated with a patient’s most recent visit, and thereby use that information to send more targeted requests for donations. I was reassured that the reply slips included information on how to opt out of future fundraising requests. [End Page 18] I was distressed that the sacred space of trust that I so carefully cultivated with each patient was being breached by the institution without my knowledge or assent. Nearly a month passed before my outrage had subsided enough for me to write to departmental leadership to share my patient’s feedback about the targeted solicitation feeling “creepy.” I did my best to make the tone of my email constructive: “I thought you might want to know in case it weighs into future discussions regarding this fundraising tactic.” In their replies, the departmental leaders highlighted the “delicate balance” between potential discomfort and making people aware of opportunities to support our mission. They acknowledged my patient’s discomfort but also highlighted a recent $10,000 donation that they attributed to these solicitation letters. I was again reassured that patients were offered the opportunity to “opt out.” The failure to notify faculty of these endeavors was acknowledged; one leader expressed that it would be “TMI” to inform us of every fundraising initiative, whereas another leader proposed sharing copies of future letters with us prior to mailing. I reiterated my personal discomfort with the tactic, acknowledging that the level of discomfort in my case likely stemmed from “the very personal nature of the discussions that transpire over the longitudinal course of caring for people with diseases that threaten their very sense of self.” I shared my opinion that offering patients the opportunity to opt out once they have received a solicitation is too late because “you can’t un-creep people out.” It would be better to allow providers the discretion to opt their patients out based on their knowledge of their patients’ circumstances. I acknowledged that institutional leaders...