I spent a few thousand dollars on cosmetic medical treatments — Botox and fillers — at a spa. The injections were performed by the dermatologist who owns the facility. I am frightened of needles and was nervous about the procedure. Afterward, I was a little out of it — maybe because of my nervousness or the numbing agent. I presented my credit card and was surprised to see a screen asking me to select a tip amount between 15 and 30 percent. I understand why they have this: Some people come to the spa for facials and other treatments performed by aestheticians. So, I selected a 20 percent tip and left. Later, when I felt back to normal, I realized that my tip was several hundred dollars. I have never been asked to tip a doctor before. Should I have been?
PATIENT
Let’s make a distinction between tip screens at coffee shops and other retail establishments, which I know aggravate some people, and tipping for medical care. Tips are always optional, but being solicited for gifts by a doctor, as you were, is really wrong. It muddles the doctor-patient relationship and is a violation of medical ethics. It’s even worse that you were asked for a tip while you felt fuzzy after a medical procedure.
Now, I agree with your theory about why this happened: It sounds as if you were at a medical spa — a hybrid business that offers traditional spa services (facials and waxing, for instance) along with cosmetic medical procedures, such as Botox injections. These businesses are pretty common; it’s also customary to tip facialists and other aestheticians — hence, the tip screen you encountered.
That doesn’t make it right, though. We can leave the gray area of tipping for facials at doctor-owned medical spas for another day. Your case is simpler: A tip screen for medical services is inappropriate. Call the spa and ask for a refund of the tip you gave. If you feel comfortable, you may also ask the doctor or spa manager to eliminate tip screens for medical services. And if you return to the spa to see the doctor again, you should feel comfortable selecting the “no tip” option.
The Best Family Plan Is the One You Stick To
Before we got married, my husband and I agreed that I would be a stay-at-home mother for our future children. Now, we’ve had our first child, and my husband is not supportive of my desire to stop working. He is a medical resident, and I’ve supported us financially throughout most of his training. He is now looking at his dream fellowship programs in some very expensive cities, and he has asked me to keep working until he is “making the big bucks.” But that’s four years away! How do I let him know I’m not on board?
DOCTOR’S WIFE
Is this Doctor Week or something? I understand your frustration. Four years is a long time in the life of a child. It probably feels like a long time to you, too, after your husband’s yearslong medical training. Speak to him directly about your household income. A medical fellowship is voluntary. It is not required to complete his medical training. What salary can your husband earn without taking one, and is it enough for your family to live on?
I sympathize with both of you. Professional ambitions are powerful, but so are your needs and the agreement you made with your husband. Insist that he take them into account as you jointly decide your family’s next steps. Maximizing his career is not the only goal here.
Nothing Says Generosity Like Keeping a List
My sister has kept a list of all the gifts she has given me that I have given away to others. Most of them were regifts. Still, I hurt her feelings. She thinks that etiquette requires a recipient to give unwanted gifts back to the giver. I say: Once it has left the giver’s hands, the recipient is free to do what she likes with it. You?
SISTER
Sorry, but you are both seriously out of step with the true spirit of gift-giving. Your sister’s keeping an eagle eye on the trajectory of her gifts to you is petty, of course. But your willingness to continue hurting her — on etiquette grounds, no less — is just as bad. I suggest calling a moratorium on gifts until the two of you can give and receive them with an affection that transcends rules and score-keeping.
An Order of Buns for the Table
This is not a life-or-death issue, but it is awkward: When leaving a banquette in a restaurant where the tables are so closely spaced that one must turn sideways to extricate oneself, should one turn to face the next table or toward one’s own table (thereby presenting one’s posterior to strangers)?
DINER
Not to be coarse, but about half of us have delicate zones at the front and back of our bodies at about table height. When possible, I ask waiters to help pull out my table so I can exit from tight spaces with dignity. When that is not possible, I assess the characters involved and take my best shot at minimizing collective discomfort. (Spoiler: I usually flash my butt at my own table.)
For help with your awkward situation, send a question to SocialQ@nytimes.com, to Philip Galanes on Facebook or @SocialQPhilip on Twitter.
