To the Editor:

The proper way to manage fees is for the patient to pay them (see “How to Handle Problems With Self-Pay Patients,” September 1998). If physicians can't figure this out, our profession is in trouble. Especially considering the number of patients who are uninsured, self-pay patients should be the basis of the practice, not the exception.

By charging $30 per visit and negotiating with laboratories and radiologists, one can drastically reduce the cost of medical care for the benefit of the patient. It's easy to chuck the clerks, coding specialists, extra computers, telephone lines, explanation-of-benefit forms and other associated silliness with which we have allowed ourselves to be saddled.

We are our own worst enemies.