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As a Primary Care doctor, I did not choose the way things are billed. This is the system I inherited when I became a doctor, and it was set by politicians and bureaucrats, not doctors. Do we have to bill this way? Sure, it is the way we get paid for our job. I hate it. And, by the way, many other doctors (most, I think) do too. The system is supposed to be designed (again, not by doctors) to reimburse physicians more money for more work done, but some patients demand more time for a physical than others, and the reimbursement is the same. The rules say (rules, once again not designed by the physician, and that this physician was following) that if there is an acute complaint in addition to a well patient visit, as there was in this case, that the physician should submit an additional charge. Perhaps physicians should get reimbursed a set dollar amount for each problem addressed, and get paid according to a set amount based on how much is determined he should make for addressing that problem, the same way a mechanic gets reimbursed so much for a tune-up, so much for an oil change, so much for changing the alternator, etc., and gets paid for each job he does. That way, if a patient comes in for high blood pressure, kidney disease, cholesterol issues, and diabetes, the physician would get paid a separate fee for addressing each of these. That would certainly have satisfied this patient since they would have known that if they gave the extra complaint to the doctor that it would include an extra charge. Many Primary Care Physicians are going to the Concierge Medicine model, where patients pay a fee (usually $1500 per year) to be a patient of the physician, then they get a certain amount of time with the physician as dictated by his policies.