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.
About the Author
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.
Yurkiewicz is working against the grain of American health care, in which patients are assumed to be consumers, not managers of it. . . . [Her] book is a detailed, moving portrait of what medicine could look like.
— Leah Libresco Sargeant - National Review
Illuminating case studies drive home the dire consequences of fragmentation . . . Persuasive and damning, this scathing indictment unsettles. — Publishers Weekly (starred review)
Moving . . . 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
Yurkiewicz makes a frightening and compelling case against a medical system that doesn’t promote—and often hinders—communication among medical caregivers, to the detriment of patients . . . An informative and sobering look at the state of patient care in the United States. — Library Journal
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. — Lucy 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
A lucid diagnosis of the systemic problem that has resulted in our ‘broken’ health-care system. Yurkiewicz allows readers to see through a young doctor's eyes as the reality of fragmentation dawns during intensely emotional situations, infusing compelling narratives with humor and humanity, and making sense of inscrutable health policy issues that affect us all. Somehow, amid the chaos, Fragmented is able to find a glimmer of hope that is desperately needed.
— James Hamblin, MD, author of Clean
Fragmented is a riveting, impassioned narrative that details the Kafka-esque paradox of American medicine: Despite having access to more information than ever, our doctors seem to know less and less about us. What makes it so uplifting and inspiring is that Yurkiewicz, an oncologist who has witnessed this problem first-hand, is optimistic that these challenges can be overcome—and that a more compassionate, humane healthcare system is within reach.
— Seth Mnookin, New York Times best-selling author and professor of science writing, Massachusetts Institute of Technology
From the intimacy of the hospital wards and her relationships with her own patients, Yurkiewicz tells the compelling story of the razor-thin margins by which medical care is delivered successfully in the United States, and how easily people can slip through the cracks of our health system. A must-read. — Mikkael A. Sekeres, MD, MS, author of Drugs and the FDA and When Blood Breaks Down