By
NBC News
updated 12/6/2005 2:40:25 PM ET 2005-12-06T19:40:25

My mother came home a little upset after her recent annual physical with the internist.

It wasn't her health that was bothering her. It was a letter she was presented on her way out of the doctor's office.

“To my patients,” it begins, “I take pleasure and pride in my practice. In order to continue to practice medicine as I do,” however, the letter continues, “I must institute an annual practice fee of $500. This fee will be in addition to what you currently pay.”

Ouch, doc, that hurts.  An “annual practice fee?" Five hundred dollars for — what, exactly? The doctor’s letter provides a long list of enumerated “services for which I do not currently charge,” including:

  • “Phone calls are returned on the same day.”
  • “When something can be more conveniently handled on the phone, I do not ask patients to come into the office.”
  • “I take enough time to know my patients.”

And then there is this inscrutable one:

  • “I take enough time to help my patients formulate their questions and to address their concerns.”

Wait: Isn’t this what doctors are supposed to do? Isn’t this part of what we patients are already paying for? Do I smell a “Maximizing Revenue In Troubled Times” seminar for physicians?

I should point out here that this particular doctor’s fees are in the upper tier already (I know this because she is my doctor, too). Since she long ago opted out of virtually every managed care plan, those fees are not being whittled down by some “reasonable & customary” fee scheme pegged to some imaginary location with imaginary doctors and imaginary patients.

Patients’ club with an annual fee?
So why, then, the sudden creation of what is, in effect, a patients’ club that requires an annual entry fee?

“My skill as a diagnostician,” the letter goes on, includes “substantial and broad experience” that “allows me to make diagnoses that, in other settings, are not made until after elaborate testing and referrals to sub-specialists.” (What “other settings” is she talking about? Whatever they are, the letter seems to suggest it would be worth $500 a year not to find out.)

To be fair, the doctor’s letter did invite any patient for whom the new $500 fee “presents an impossible barrier” to speak to her about it.  

Moreover, upon further reflection, I came to realize that, instead of feeling blackmailed by this unexpected surcharge for services I thought I was already paying for, what I really should be doing is following my doctor’s lead.

And so, like the doctor, I will begin collecting fees each fall for the coming year, from just about everybody with whom I interact.

To my parents:
Mom and Dad, I take pleasure and pride in being your daughter, but because my style of daughtering is not typical in this time of family strife, and in order to continue to practice daughtering as I do, I must institute an annual “Daughtering Fee” of $200.

I hope you agree that this is both reasonable and rock-bottom for the quality of service I provide.

Phone calls are returned on the same day. When something can be more conveniently handled on the phone, I do not ask you to come to my home. I even make house calls to your home when necessary, although I acknowledge that sometimes there must be the lure of a meal or the anticipation of a gift.

Last but not least, I think we can all agree that I have taken a long time — years — to really get to know you; my style of daughtering does not resemble the drive-up window at McDonald’s.

To my employer: 
Dear Mr. Bossman, it is an honor to be your worker bee. I have not, however, been charging you for much of what is important in a good employee.

That is about to change; from now on, I must institute an annual “Worker Fee” of $10,000.

This fee, in addition to my regular paycheck, will cover everything from the fact that I graduated high school and college in four years apiece, to my willingness to come in to the office in the morning and stay until the early evening.

But wait: there’s more. The annual fee also covers my superior ability to do my job even as I engage in steel cage eBay death matches from the comfort of my cubicle.

To my friends:
Dear Friends, it is a source of pride to be chosen as someone’s friend. I would very much like to continue to be your friend. And I can, indeed, continue to do so once you remit my annual “Friendship Fee” of $350-$450, depending on how high-maintenance you are.

Please make an appointment so that I can make this diagnosis, which, I promise, will not require elaborate testing or referrals to sub-specialists, thus saving you considerable time, anxiety, and money.

It goes without saying, but I will say it anyway, that in this time of superficial, boring, and stupid people, I am a substantive, interesting, and witty companion.

If my annual “Friendship Fee” presents an impossible barrier for you, please feel free to speak to me about it; but please remember, also, that there is a virtually unlimited pool of potential new friends out there. I can replace you in an instant. Love ya!

And finally, To my Chinese takeout place: 
Dear Noodle Corner, it is an honor to receive your free delivery, even when the meal you’ve delivered is somebody else’s order. It is, in addition, a pleasure trying to make sense out of the fortunes in your cookies.

I would like to continue to be your customer, but in order to continue placing orders as I do, I must institute an annual “Soy Sauce Delivery Fee” of $69.95 (you end all your prices with “$.95,” so I hope my doing so as well will persuade you that I have taken the time to really know you).

Not that you need reminding, but I would remind you that my practice as a customer of your establishment includes: willingness to stay on interminable hold while you juggle multiple phone calls and demands that, let’s face it, you should be better staffed for; knowledge of the names and item numbers for everything I order; payment, always, in cold hard cash; and rounding up — every time — when I tip your delivery person.

I feel better already. Thanks, Doc.                              

Barbara Raab is a New York City-based lawyer and writer for "NBC Nightly News with Brian Williams."

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