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)