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Expanding the Tip Jar to Clinicians

While tipping has become common across many types of services, this practice is not acceptable within dental hygiene.

In February, readers of Dimensions of Dental Hygiene received an email from Executive Editor Kristen Pratt Machado with a link to a guest commentary that appeared in the Baltimore Sun.1 An ophthalmologist opined about whether the tip jar should be expanded to include healthcare professionals.2 The author, Eric Dessner, MD, noted that people tip many types of workers to acknowledge good service and show gratitude. He points out that it is time to reconsider “who has been left out in the cold” and specifically refers to nurses and dental hygienists. Dessner adds that he feels a stronger sense of gratitude toward his dental hygienist, who “spends an hour scraping away tartar from the base of my teeth,” than he does toward hotel bellmen, bartenders, and servers.2

He writes that medical doctors, dentists, podiatrists, and such are amply reimbursed, and that if these professionals even flirted with the idea of accepting additional gratuity, it would tarnish the sanctity of the bond between the patient and professional. I’d like to suggest to Dessner that the proper grouping of dental hygienists is with the healthcare providers rather than with hotel, restaurant, and bar service providers. Dental hygienists and their patients also share an honorable trust bond.

Gifts and monetary rewards for healthcare providers can be viewed under the general heading of professional boundaries and conflict of interest. The professional relationship is one of unbalanced power. Such a relationship exists for the well-being of the patient, not for the provider. We need to stay cognizant of the principles of healthcare ethics.

When patients bring gifts, even as simple as baked goods, is it truly a basic thank you or could there be a conscious or unconscious expectation for extra care or considerations at future visits? In contrast, one interacts with a hotel bellhop just once, making the idea of a future expectation irrelevant.

Rather than instituting explicit policy about accepting gifts, most professional organizations recommend making such decisions on a case-by-case basis. It is suggested that appropriate gifts of low monetary value are relatively safe, which begs the question, how low is low enough?

Perhaps a grateful couple you treat offers you a weekend getaway at their second home. Should you reject this gift? It could be argued that this offer did not have a monetary price and that refusing it could offend the gift giver. However, once provider and patient adopt a different relationship, the integrity of the relationship is altered. The giver may now feel elevated above the status of the usual patient and expect special treatment. Impartiality may be affected and critical judgments altered (such as the admonition regarding treating friends and family).

You may counter that baked goods or chocolates — relatively inexpensive gestures often brought into dental settings (an interesting choice considering sugar is an enemy) — would not create bias toward that patient. However, if you had a tightly booked schedule and an unexpected opening, who would you offer it to first?

Providers can feel conflicted when a grateful patient offers a gift of appreciation. Adopting a policy of accepting no gifts avoids the need for judgment calls about each particular offering. Each provider should carefully consider the issues involved and create a personal policy based on principles of healthcare ethics.

So, I’d say to Dessner, we appreciate your statement about dental hygienists and nurses that “the honest hard work that they perform in the trenches every day should not just be recognized, but it should finally be rewarded with an opportunity for better compensation.” But please don’t suggest that our patients tip us.


  1. Machado KP. Should dental hygienists receive tips? Available at: Accessed May 22, 2023.
  2. Dessner E. Rethinking access to the American tip jar. Baltimore Sun. February 9, 2023.

From Dimensions of Dental Hygiene. June 2023; 21(6):13.

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