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A Doctor's Quest to Piece Together American Health Care
by Ilana Yurkiewicz MD
An award-winning physician-writer exposes how pervasive cracks in the health care system cost us time, energy, and lives―and how we can fix them.
There's an unspoken assumption when we go to see a doctor: the doctor knows our medical story and is making decisions based on that story. But reality frequently falls short. Medical records vanish when we switch doctors. Critical details of life-saving treatment plans get lost in muddled electronic charts. The doctors we see change according to specialty, hospital shifts, or an insurer's whims. Physician Ilana Yurkiewicz calls this phenomenon fragmentation, and, she argues, it's the central failure of health care today.
In this gripping narrative from medicine's front lines, Yurkiewicz reveals how a system that doesn't talk to itself puts insupportable burdens on physicians, patients, and caregivers, forcing them to heroic lengths to hold the pieces together―barely. The stories she tells are at once harrowing and commonplace. A patient narrowly averts an unnecessary, invasive heart procedure by producing a worn rhythm strip he has carried in his pocket for a decade. A man diagnosed with leukemia while visiting from abroad has thirty-one physicians, but no one he can call "his" doctor, with tragic consequences. When Yurkiewicz's own father falls ill, a culture that incentivizes health care providers to react with quick fixes to the problems immediately before them―often to the neglect of a patient's overall narrative―leads to weeks of additional suffering and a risky hospital transfer.
The system is hanging by a thread, and we need better solutions. Yurkiewicz issues a clear-eyed call for change, naming concrete reforms doctors and policymakers can make, and empowering patients and their loved ones to advocate for themselves in the meantime. Urgent, radiantly humane, and ultimately hopeful, Fragmented a prescription for what really needs fixing in modern medicine.
"Illuminating case studies drive home the dire consequences of fragmentation...Persuasive and damning, this scathing indictment unsettles." ―Publishers Weekly (starred review)
"[M]oving...Yurkiewicz's poignant prose reads like a novel...An engaging read that paints an honest picture of how a broken system impacts patients and providers." ―Kirkus Reviews
"Fragmented is a bravura feat of synthesis, showing how so many failings of America's health care system are actually facets of the same horrible problem. It's a call to arms, showing that said problem is intolerable and fixable. It's an essential book, possessed of a ferocious urgency and anchored by Ilana Yurkiewicz's stirring, compassionate writing." ―Ed Yong, New York Times best-selling author and winner of the Pulitzer Prize
"A beautiful meditation on and exposé of the failures and opportunities in American health care. Ilana Yurkiewicz brings her singular voice―as a brilliant doctor scrabbling to provide top-notch care, a vulnerable daughter actively bridging gaps during her own father's serious illness, and an expert observer of systems and policy―to this crucial book full of empathy, gripping stories, and hard-won wisdom about how to achieve better care for us all. I loved it." ―Luy Kalanithi, MD, Stanford School of Medicine, and widow of Paul Kalanithi, author of When Breath Becomes Air
"American health care is so technically advanced, the spawning ground for life-changing medical breakthroughs, yet it fails so many by being dysfunctional, absurdly costly, and uneven...Ilana Yurkiewicz combines lucid prose, astute observations as a frontline provider, and incredible empathy to dissect this paradox in an unforgettable way...An important book." ―Abraham Verghese, author of The Covenant of Water and Cutting for Stone
"Urgent, timely, and eye-opening." ―Danielle Ofri, MD, PhD, author of When We Do Harm
This information about Fragmented was first featured
in "The BookBrowse Review" - BookBrowse's membership magazine, and in our weekly "Publishing This Week" newsletter. Publication information is for the USA, and (unless stated otherwise) represents the first print edition. The reviews are necessarily limited to those that were available to us ahead of publication. If you are the publisher or author and feel that they do not properly reflect the range of media opinion now available, send us a message with the mainstream reviews that you would like to see added.
Any "Author Information" displayed below reflects the author's biography at the time this particular book was published.
Ilana Yurkiewicz, MD, is an oncologist and internal medicine physician on the faculty at Stanford Medicine. Her medical journalism has been published in The Atlantic, Scientific American, Undark, The Best American Science and Nature Writing, and elsewhere. She lives in Palo Alto, CA.
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