We can work it out: Should I hire my patient?
Certain types of barter should be off limits, including:
- trading prescription drugs for goods or services
- trading for services that tie into the success of one’s business (eg, business advising or marketing)16
- offering treatment in exchange for illegal or ethically unacceptable services.48
Beyond ethical considerations are some practical issues. The Internal Revenue Service has specific rules regarding taxation of bartered goods and services, which must be included as taxable income.46 If possible, an independent agent should appraise the traded goods or services before the agreement.6 When working in a group practice, the clinician might have to figure out how to allocate the received goods or services such as shared overhead costs.28 Preferably, the patient’s goods or services should be provided before care is delivered.16 If not, the duration of services rendered should be limited, and either party should have the option to disengage from the relationship if one feels dissatisfied.16
A written contract, discussed ahead of time, can be a sound way to summarize the terms of the arrangement. Both sides also should consider what would happen if an injury occurred.16 Finally, you must adhere to any relevant state laws regarding payment for services, particularly if the patient has health insurance.32
If the bartering arrangement does not work, you should take an open and non-defensive approach. If you believe you have made a mistake, consider apologizing.45
