Paper short abstract:

The circulation of gifts in the physician's office creates identities and a culture in which past and present values combine and collide. The fact that different strategies coexist makes the act of gifting harder to interpret and this questions the value of macro-studies for future policy changes.

Paper long abstract:

The circulation of gifts in the family physician's office is a performative action that creates identities and a culture in which past and present values collude and collide. A part of these gifting activities is a remnant of the Communist past when gifts would open doors and provide access to services that should have been free. This is the culture that most resembles the assumptions that underlie any market exchange, but there is also a culture of care that inspires gifting as a form of reciprocating the attention given by the doctor to the patient. In this case the patient is responding to what it can be perceived as the initial gift, the gift of care, with an object that symbolizes a deeper connection. There are also some gifts that circulate deeper into the system mimicking the institution of a distributive justice, from those who have more to those who have less. The fact that these many nuances and strategies coexist makes the act of gifting harder to interpret for the outsider and the insider as well. As a result each act has to be viewed in its singularity, in the historical context of the relationship, the moment and the stated intentions for the future of the actors involved. The implications for those that perform macro-analyses of gifting between patients and doctors and those that make suggestions for future policies in this field are discussed.