Fragmented

An award-winning physician-writer reveals 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 you go to see a doctor: the doctor knows your medical story and is making decisions based on that story. But the 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.

Stanford physician Ilana Yurkiewicz calls this fragmentation, and, she reveals, it’s the central failure of health care today. In this gripping narrative from medicine’s front lines, she shows how a system that doesn’t talk to itself forces doctors, patients, and their loved ones to go to heroic lengths to bridge the gaps. With lives at stake and little other choice, we all do so―but the system is hanging by a thread, and we need better solutions. Radiantly humane, empowering, and ultimately hopeful, Fragmented is a prescription for what really needs fixing in modern medicine.

Read an excerpt at MedPage Today.

Available From

Audiobook

Reviews & Lists

“Startling debut … Persuasive and damning, this scathing indictment unsettles.” Publishers Weekly, starred

“Yurkiewicz’s poignant prose reads like a novel, knitting patient and personal stories with an honest insider’s evaluation of a highly problematic system.” 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

“Yurkiewicz, an oncologist and internist at Stanford Medicine as well as a journalist, describes a behind-the-scenes reality that the public rarely sees: doctors scrambling to collect patient records.” Undark

“Yurkiewicz’s book is a detailed, moving portrait of what medicine could look like, but few doctors have her opportunity to build a countercultural clinic. For a policy wonk, her book is a guide to the barriers that need to be removed to allow doctors to heal. For a physician, the book might be an inducement to leave the profession as conventionally practiced rather than continue to work in a system that is built to fail.” National Review

“Discontinuities caused by insurance companies, reliance on software and contemporary medical culture are the U.S. health care system’s ‘greatest problem,’ writes Yurkiewicz.” New York Times

Health Affairs “17 Fascinating Health And Health Policy Books”

Next Big Idea Club Must-Read

St. Louis Post-Dispatch Summer Books recommendation

Interviews

NPR’s Marketplace | July 20, 2023

Talk Nerdy Podcast | July 24, 2023

Health Unabashed Podcast | July 19, 2023

Healthcare Unfiltered Podcast | July 25, 2023

The Armen Show Podcast | July 11, 2023

Association of Health Care Journalists Q&A | August 22, 2023

Next Big Idea Club: 5 Key Insights from Fragmented | July 28, 2023

National Association of Science Writers Interview | July 2023

Events

A Company of Authors | April 20, 2024 | Stanford University, Stanford, CA | Open to the public

Stanford Medicine Grand Rounds | January 17, 2024 | Watch the recording on YouTube

Author Talk: Piecing Together American Health Care | 12pm ET Wednesday, November 8, 2023 | Gwinnett County Public Library | Virtual, open to the public | Watch the recording on YouTube

Stanford Big Ideas in Medicine Conference | September 9-10, 2023 | Stanford University, Stanford, CA | Open to the public

Stanford & UCSF Medicine Mixer and Book Reading | 12-2pm PT Sunday, August 20, 2023 | Stanford University, Stanford, CA | Open to faculty and students

Stanford Medicine Book Reading & Discussion | 5:30-7:30pm PT Wednesday, August 9, 2023 | Stanford Health Library, Stanford, CA | Free and open to public

Columbia University Medical Center Book Reading & Discussion | Monday, July 17, 2023 | Columbia Milstein Hospital, New York, NY | Open to faculty and staff

Praise

“Fragmented is a bravura feat of synthesis, showing how so many failings of America’s healthcare 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, winner of the Pulitzer Prize and New York Times bestselling author of An Immense World

“A beautiful meditation on and exposé of the failures and opportunities in American healthcare. 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 this book.”

–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. In Fragmented, Yurkiewicz combines lucid prose, astute observations as a front-line provider, and incredible empathy to dissect out this paradox in an unforgettable way. Fragmented is an important book, an urgent call for change.”

–Abraham Verghese, author of The Covenant of Water and Cutting for Stone

“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 at MIT

“The digital revolution was supposed to convert healthcare into a well-oiled system of data sharing and usability. This insider physician's account of how the sausage is actually made suggests otherwise, and it's the patients who have the most at risk. Urgent, timely, and eye-opening.”

–Danielle Ofri, MD, PhD, author of When We Do Harm: A Doctor Confronts Medical Error

“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 realization unfolds 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

“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

Beyond the Book: Instagram Videos

Practical advice for navigating our fragmented health care system