Fragmented (A Doctor's Quest to Piece Together American Health Care)

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.