Telltale Hearts

June 1, 2024
A family doctor describes a powerful healing technique. Schillinger, professor of primary care and health policy at the University of California San Francisco, joins many colleagues who deplore today's technology-heavy, medication-oriented health care system, which often isolates patients from doctors and contributes to treatment failures. He reminds readers that it's been proved that the greatest source of information for doctors is not a test or machine, but what a patient tells them. He illustrates his approach with a steady stream of stories from his years of training at San Francisco General Hospital and practice at the UCSF Center for Vulnerable Populations, which he co-founded. Examining the monumental struggles of marginalized communities, he makes a painfully convincing case that the present system guarantees that the poor get sicker, receive less care, and die sooner. The author's stories are consistently illuminating: A man unable to walk reveals that he is an alcoholic and has lain unconscious for such long periods that his leg muscles have withered. A "frequent flyer" patient with scores of visits for problems stemming from her drug addiction, complicated by an obnoxious personality, appears 20 years later, drug-free and raising a child, grateful to the author and a few others who were kind to her. Schillinger devotes much of his text to diabetes, a public health problem as serious as those caused by tobacco. His campaign to place a warning label on sugared soft drinks, essentially liquid candy, faced an uphill battle. However, as the author writes, he knew that "to declare and wage a war against diabetes, I needed to separate from a bureaucracy currently paralyzed by conflicts of interests and politics, and pursue an alternative strategy." In this often inspiring book, he shows readers a variety of "alternative" strategies that benefit public health. Vivid medical anecdotes with occasional happy endings.

COPYRIGHT(2024) Kirkus Reviews, ALL RIGHTS RESERVED.

Starred review from June 1, 2024
When you imagine a doctor, your first thought is likely a stethoscope and white lab coat, maybe a scalpel or syringe. But a doctor's ears are their most important tool, and patience is a high-ranking attribute. Schillinger, a public health leader and primary care physician in San Francisco, concentrates on the essentiality of listening in the care of patients. Regarding the usefulness of medical interviews, he wisely writes, ""in the story lies the answers."" Yet doctors increasingly defer to blood tests and imaging studies rather than relying on the diagnostic value and therapeutic power of these stories as a physician's time spent with patients is increasingly truncated. Many of Schillinger's patients belong to marginalized populations. The waiting room of his outpatient clinic is packed with uninsured people, old folks, disabled individuals, and substance abusers. Plentiful tales of patients and diseases (serious infections, cancer, mysterious breast pain, heart failure, diabetes, sickle cell anemia) are included. His immersion in the daily suffering and misfortune of fellow human beings exacts a heavy toll on Schillinger. He recounts his severe episode of depression. The description of the doctor's emotional condition and that of his patients sometimes surprisingly overlaps: frustration, traumatization, vulnerability, shame, failure. A humble and honest, heroic and heartrending account of humanistic medicine.

COPYRIGHT(2024) Booklist, ALL RIGHTS RESERVED.

August 12, 2024
San Francisco General Hospital physician Schillinger argues for the importance of listening closely to medical patients while highlighting the inequalities that plague the American healthcare system in this impassioned memoir. “The combination of science and stories holds the key to recovery,” Schillinger begins, decrying medicine’s tendency to “devalue stories” in favor of formulaic treatment. For much of the account, Schillinger reconstructs patient testimonies that have informed crucial treatment decisions across his three-decade career, including that of a construction worker who switched to liquid blood pressure medicine after admitting to Schillinger he couldn’t swallow pills. Other chapters delve into Schillinger’s experiences treating AIDS patients in “the trenches” of the early epidemic, and his efforts to fight obesity as the California Department of Public Health’s chief of diabetes control. Throughout, Schillinger keeps a sharp eye on the contrast between the options available to patients at San Francisco General, a public hospital, with other, private Bay Area institutions, most memorably through a heartbreaking anecdote about failing to get a patient with signs of cancer bumped up on a treatment list. Schillinger’s palpable empathy and narrative skill underscores his conviction that “stories can break down barriers and open up windows into other people’s lives.” The results are moving. Agent: Bonnie Nadell, Hill Nadell Literary.