Q. I have treated a patient for a number of years; she is doing well, but needs continued treatment. The patient has always struggled with her financial obligation, but currently is very concerned about being able to continue to pay for treatment. She has asked if she could, on a temporary basis, work off a portion of her charges for each session. She has suggested cleaning my office, doing my shopping, filing, and so on. Initially I was opposed to her suggestion, but several of my colleagues do not think there would be a problem with such an arrangement. Would it be O.K. to agree to this arrangement?