I am taking a leave of absence from my previous life. I used to work as a doctor at a large academic medical center in Northern Manhattan. Half of my time was devoted to my practice; I was a primary care doctor in a clinic attached to the medical center. The other half of my time was spent teaching medical students and medical residents bedside clinical medicine.
Although my patients in New York are poor by US standards (mostly immigrants, elderly, a few working poor), I sent them for endless expensive high-tech diagnostic tests. I also prescribed thousands of dollars of medicines per patient per year. Many of them were taking more than 10 or even 20 medicines daily for their chronic diseases: obesity, hypertension, diabetes, coronary artery disease, cerebrovascular disease, heart, liver, and renal failure.
In medical school I learned how to order diagnostic tests. Testing and expensive treatment for chronic disease are generally accepted as the "standard of care" in tertiary modern American medicine. I learned to practice this way during my residency training. I also taught my medical students and residents how to practice this way.
However, the problems in the American health care system--the paperwork, the insurance system, the waste inherent in multiple often unnecessary diagnostic tests, the administrative demands on primary care doctors, and the lack of care available to the uninsured/underinsured population-- started to bother me. Things that were driving me crazy: patient requests for $6000 motorized "scooters," patient requests for "brand name medicines," serial MRIs for tension headaches, "prior authorizations" for Medicare meds, Tayna in 207, sad state of innovative medical education at certain Upper Manhattan Medical Center. I wanted to go somewhere with different problems.