Fragmented A doctor's quest to piece together American health care

"Fragmentation--or the insertion of gaps into a patient's story, which blindfolds health care workers to the whole--is the single greatest problem underlying American health care," argues oncologist Yurkiewicz in her startling debut. Drawing on incidents from her career, she examines how discontinuities in the health care system caused by record-keeping software, insurance companies, and a medical culture focused on specialization all lead to inferior treatment. Electronic medical records, she posits, are often too disorganized to be useful, and she recounts the difficulty she had working at a hospital where she had to pore over extensive records while tending to 15 patients and "getting paged five to ten times an hour." Yurkiewicz emphasizes the benefits of seeing the same doctor for long-term medical care and excoriates insurance companies for deprioritizing follow-up visits by reimbursing doctors more for first-time appointments. Illuminating case studies drive home the dire consequences of fragmentation and show how breakdowns in care happen, such as the story of an infectious disease doctor who, examining Yurkiewicz's patient through his "lens of expertise," missed the presence of a rare fatal infection because he failed to account for symptoms that fell outside his specialization. Persuasive and damning, this scathing indictment unsettles. (July)

A reflective doctor uses moving stories to reveal huge gaps and potential fixes in the deeply flawed American health care system. Yurkiewicz's poignant prose reads like a novel, knitting patient and personal stories with an honest insider's evaluation of a highly problematic system. The author, a physician on the faculty of Stanford Medicine, writes from her experiences as a resident, fellow, oncologist, and caregiver. As she states, the system is designed for reaction and "shifts blame onto individuals instead of focusing on sustainable systemic changes," leaving patients and their families at serious risk. Yurkiewicz describes three major issues with the American health care system and presents the potential solutions. In the first part, "The Data Dig," the author tackles the massive difficulties she encounters with electronic medical records. When a patient has a complex history, attempting to treat them is "like opening a book to page 200 and being asked to write page 201." In the second section of the book, "Lost to Follow-Up," Yurkiewicz calls for a more preventative-focused system. She uses multiple patient stories to explain the critical, yet common, problem of fielding a full team of doctors and illuminates the many issues involved with the pernicious 28-hour shift, "a rite of passage for doctors." In "The Stories We Tell Ourselves," the author criticizes many enduring myths about the U.S. health care system, and in the chapter titled "These Things Happen," she examines her subject through the lens of her caregiving role for her ill father. "I started to see my dad's hospitalization as an endless series of branch points: each of them could make or break the recovery of a critically ill person…His medical care was a game of risk." Though Yurkiewicz may not fully solve the health care game, she provides plenty of food for thought for caregivers and medical professionals. An engaging read that paints an honest picture of how a broken system impacts patients and providers. Copyright (c) Kirkus Reviews, used with permission.