Dear June,

I go to a very nice local dentist who charges rather high prices but sometimes gives struggling families a break. Over a year ago my husband and I both lost our jobs, right after we had bought a house that was kind of a stretch. Suffice it to say that our finances are a total mess, and I told my dentist that we were switching to yearly cleanings for the kids, and that I would rather just have my tooth pulled instead of getting a root canal and crown, because we simply could not afford it. He said that he would give me a lower price and a payment plan, but I could not afford that, either. So then he gave me a drastically reduced rate, practically free service, which I thought was really sweet. But then a neighbor of mine, who is—I know this is complicated, but this is how gossip works in my neighborhood—the cousin of the wife of one of my dentist’s partners, told me how sorry she was to hear about my financial problems, but said how thoughtful and generous it was of Doctor Bountiful (not his real name, although I am tempted to use it!) to be helping me out. So he must have been telling his wife and perhaps other people about my family’s money situation. Is this ethical? He may not have said anything much about my actual treatment, except that he must have mentioned that I had a crown put in because my neighbor knew that. But even talking about the financial stuff, is there a duty of confidentiality? The fact is that I care much more about people knowing what desperate condition we are in than knowing about whether I had my tooth fixed!

Is there anything I can do about this? I don’t want to sue or file a complaint or anything, even if I had a chance of winning. Even just talking to him I would be worried about antagonizing him, since he has been so nice to me. And I might need him to be nice to me and the kids again in the future. But I still wish there were some way I could let him know that he should not be behaving like this.

Thanks,

—Embarrassed in Englewood

Dear Em in En,

Dentists and their employees, like doctors, do have a duty to protect their patients’ personal health information (PHI). Federal law requires it. The general, somewhat oversimplified rule is that, unless you or a court of law asks for it, your dental-care providers can only release PHI for reasons that are relevant to providing treatment or securing payment. The American Dental Association has its own privacy rules, and local professional associations, as well as state authorities, usually also have longstanding rules about privacy and confidentiality that apply to health information, medical or dental.

Whether information about billing and payment, and information about your personal finances, count as health information is more of a grey area, to me anyway. I believe that they do, for several reasons. But this does not really matter, since whoever told tales also let it be known that you got a crown from Dr. Bountiful, which is clearly covered by privacy rules. And you do not plan to take any formal action anyway.

The real questions, then, are whether what was done to you was wrong, and what you can do about it.

It was wrong, of course. Even if the law and rules of professional ethics did not forbid this violation of your right to privacy, basic human ethics certainly would. Most people want to keep their financial situation private, especially if they are having difficulties. Many people would also just as soon not have it be known that they’ve been the object of charity. There may be good reasons for discretion—someone’s reputation, perhaps even their livelihood, may depend on whether this information is revealed, and in what way. But there does not need to be a reason: we should all respect one another’s privacy in areas where we know, or should know, that people value it.

Dr. Bountiful, or somebody who works with him, behaved badly. They may have been careless—by, say, letting themselves be overheard, or leaving papers out where they could be seen by an unauthorized person. Or they may have been heedless blabbermouths who placed their desire to gossip over your right to privacy, which I find worse. Or they may have actually thought about what they were doing and decided that giving somebody treatment for free destroys the right to privacy, which I find worst of all.

Actually, it may be worse yet if one or more of the divulgers was not just gossiping about being charitable to you, but actually bragging about it. I am a big fan of heeding Matthew 6 and not doing your charitable deeds “before men, to be seen by them.” Matthew tells us that when being charitable, you should “not let your right hand know what your left is doing.” His main focus is on getting your reward in heaven, while mine is on not being condescending and generally tacky, but we end up in the same place—as does the great Maimonides, by the way.

While I’m at it, let me add that, from a treatment perspective, loose lips like those at Dr. Bountiful’s office create a loss of trust that could interfere with the dentist- patient relationship in the future—or that might, in fact, discourage you and your family from seeking treatment from him or anybody else until your situation becomes dire.

Yes, you are thinking, but is there anything I should do about this? Anything I can do?

What you obviously can’t do is undo the harm Dr. Bountiful’s practice has already done. You can try to contain the damage by downplaying your anxiety if anyone mentions it again—say something like “yes, that was nice of Dr. B,” and have a change of subject ready. You can also ask trusted friends not to discuss the matter with anybody new, and to minimize your current financial problems if anyone else raises the topic.

I do think you should say something to Dr. Bountiful, unless you believe that bringing the matter up at all, ever, will make it harder for you to get affordable treatment.

One reason you should talk to him is that he may not even know what’s going on. The leak may have come from somebody who actually had an acceptable reason to know about the situation—his partner, his business manager, or the person who handles the billing—and Dr. Bountiful may be both blameless and ignorant. Or he may be less blameless—say, if he blabbed to his hygienist, or told his wife but swore her to secrecy—but still ignorant that the information went any further. In either case, you will be doing him and your fellow patients a service if you tell him how far the story has travelled. He may even be grateful, although I would not hold my breath.

But the main reason to tell him, of course, is to get him to stop—with you and with any other recipients of his generosity. He needs to know that your privacy and dignity matter.

If you have any reason to believe that he or those around him are still talking about the matter, it would make sense to get in touch with him now. If not, you can take your time to contact him, even wait until your next visit so you can speak to him in person, and perhaps less formally. (I prefer letters, but tastes and talents differ.)

Unless you know, and you know he knows you know (etc.), that he is the source of the gossip, I would talk or write to Dr. Bountiful as if he has no idea what happened. Here are some talking points, in letter form.

Dear Dr. Bountiful,  

First, thank you so much for your generosity and skill. I will always be grateful for it.

I wanted to alert you that someone in your office somehow let it out that you put in a crown for me at very low cost because my family is in financial trouble. (I know this because a neighbor mentioned it to me.) Needless to say, my husband and I are trying to get back on our feet and do not want the details of our situation generally known. Like most people, we value our privacy and our reputations very highly. 

I am less concerned that one of my neighbors somehow found out about my crown—but I can’t see why my personal health information [that’s the technical term, which it’s good to let him know you’ve seen] is their business!

I am hoping that you can speak to your staff about this. I’m sure you understand how important privacy can be, especially in hard times. 

Thanks again for making it possible for me to get the crown, and for your great work. The crown looks good and seems to fit just fine.  

Please give my warmest regards to Mrs. Bountiful. Hope Little Bountiful aced the regionals. 

Yours, etc.

If you decide to speak to him in person, I’d take the same basic tack, but probably be a bit more effusive in your thanks, and detailed in your concern.

By the way, are you quite sure you want to continue going to this dentist? Are there more affordable options, at least for routine work? Is there a nearby dental school with a clinic? You say that Dr. Bountiful is “really nice,” but when you write about not antagonizing him, and needing him to keep being nice to you, he sounds more like the godfather, or the proprietor of the company store.

If you do feel that his office is the only choice for you, I hope that he is indeed a “really nice” person, and not the sort to take offense at hearing the valid concerns of a patient who happens to be in straitened circumstances. If he is a good person, a few words from you should ensure that he and his staffers do not “sound a trumpet before them as the hypocrites do,” whether for “glory among men” or gossip among neighbors.

Dear June, 

Yesterday night my husband and I got into a big fight. This morning I found an enormous, perfectly ripe avocado in our crisper and instead of saving half of it for him, as I usually do when we have a finite amount of fruits and veggies, I ate the whole thing myself. Was I wrong? 

—Remorseful in Reading

Dear ReRe,

Depending on how much other good food there was in the house, and how much your husband is known to like avocados, you were either not very wrong or not wrong at all. On the whole, it sounds as if you are doing just fine morally. In fact, if this is the sort of thing that fills you with genuine remorse, you are probably some kind of saint.

I suspect that, for you, the avocado in question is not just any old veggie-like single-seeded berry, but a symbol of one or more problems in your marriage. Try to bear in mind that, unless you come to blows or somebody gets verbally abusive, marital disagreements are normal and can even be healthy. But if you really are worried about how things are going between you and your partner, it never—well, hardly ever—hurts to talk the matter over with your spouse or, if you believe or know this will not work, with a professional.

How about going out and buying some more luscious avocados? You can give your husband enough to assuage all lingering avocado-based guilt, and still have plenty of avocado flesh left over for guacamole or trendy toast.

By the way, be sure never to cut an avocado in anger. You could hurt yourself. For reasons I fail to understand given the state of our democracy, the polar ice cap, and the Doomsday Clock, avocado-cutting safety seems to be a hot topic on the Internet these days. There are some great YouTube videos about the best way to cut and peel avocados. If you are not a master avocado cutter already, check one out. You may save your fingers, and you’ll learn about this fun thing to do with the edge of your knife.

Cleaver’s in-house advice columnist opines on matters punctuational, interpersonal, and philosophical, spinning wit and literary wisdom in response to your ethical quandaries. Write to her at [email protected]. Find more columns by June in her attic.