Fragmented: A Doctor’s Quest To Piece Together American Health Care

Physician and medical journalist 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. The author, an oncologist, recounts her encounters with patients who carry from appointment to appointment yellow notepads of handwritten notes or binders filled with pages of records because medical records systems have failed them. The book notes that even with herculean efforts made by conscientious physicians such as Yurkiewicz, vital information is often missed or misinterpreted. Adding to the confusion is that only one out of every four Americans has a primary-care physician, and even those with insurance often fail to receive effective follow-up care. The book compares the fragmentation in medicine to Swiss cheese, in which the holes in each layer increase the potential for gaps in patient care. Yurkiewicz argues for addressing all these issues and practicing “big picture” patient treatment rather than responding to “snapshots in time.” The book includes a checklist for patients, as Yurkiewicz notes that patients themselves are the only guaranteed source of continuity in their own care.