Women And children first

 . The Centers for Disease Control and Prevention issued an advisory recommending that the sick and elderly receive priority in vaccination. That was like shout- ing “Women and children first!” aboard a sinking ship. Patients never be- fore willing to receive the flu vaccine oddly now demanded one

 “I forgot my wallet.... Just bill my insurance.... My son handles my checkbook.... Under our divorce agreement, my ex-husband pays all of my daughter’s medical bills.... I’m shocked, shocked that you don’t ac- cept American Express!” Patients who would willingly whip out their wallets for their pets at the vet, for groceries in the supermarket, or for a haircut, suddenly develop tight-fist syndrome in the doctor’s office. Debt consolidators and personal financial consultants advise: “Pay your doctor last.”

A tenacious health insurance biller is one of a physician’s most highly valued staff members, a specialist in his or her own right, worthy of com- bat pay. My busy practice required that I maintain one full-time employee whose 

 Maintenance of an Office of the Exchequer, focused by necessity on the fiscal fitness of the practice rather than the physical health