TELLTALE HEARTS

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.