Telltale Hearts: A Public Health Doctor, His Patients, and the Power of Story

by Dean-David Schillinger

 A doctor's powerful meditation on what his patients taught him and what they can teach us about health, empathy and healing.  For over four decades, Dr. Dean-David Schillinger has been a witness to the evolution of public health in America. From his days as a young, bright eyed resident to the Chief of Internal Medicine at one of the country's largest public hospitals, Schillinger has seen thousands of patients and observed how our healthcare system can both work for and against them. Yet, it wasn't insurance or improved medical tests that mattered most; it was simply listening to his patients.  In Telltale Hearts, Schillinger takes readers into the exam rooms of a public hospital as he recounts his various experiences with patients and how listening to their stories, their backgrounds and more, revolutionized his own approach to medicine. In a hospital that serves mostly low income and marginalized populations, it was never just the injury or ailment that was the whole story but rather the social, political and racial circumstances that led patients to the hospital in the first place.  A woman who refuses to take her pills actually cannot swallow them to begin with while another who seems to be skipping her insulin injections has a family member who is stealing them.  A patient with Type 2 diabetes doesn't just suffer from high blood sugar but has consistently lived in a food desert where sugary beverages and unhealthy food were the only options. With each story and each patient, Schillinger urges us to look at how listening to patients not only can lead to better care in a hospital, but a more empathetic approach to public health in general.  Written with compassion and introspection, Telltale Hearts is a moving portrait of modern medicine and an urgent call for change in how we, as a society, take care of our own.    

Genres: Nonfiction, Medical, Memoir, Health, Science

368 pages, Hardcover

Published July 16, 2024

About the author

Dean-David Schillinger MD is a primary care physician, scientist, author, and public health advocate. He is an internationally renowned expert in health communication and has been widely recognized for his work related to improving the health of marginalized populations. He is credited with a number of discoveries in primary care and health communication and is considered a pioneer of the field of health literacy. He is the inaugural recipient of the Andrew B. Bindman Professorship in Primary Care and Health Policy at the University of California San Francisco (UCSF). Dr. Schillinger has served as chief of the UCSF Division of General Internal Medicine at San Francisco General Hospital, and chief of the Diabetes Prevention and Control Program for the California Department of Public Health. In 2006, he co-founded the UCSF Center for Vulnerable Populations, a leading research center committed to addressing the social, environmental and commercial determinants of health through research, education, policy, and practice. He currently directs the UCSF Health Communications Research Program.

Reviews

[Keri Karman · Rating 4 out of 5]

Dr. Schillinger does a great job at "finding meaning in medicine" through the stories of patients he encounters as working as an internist at a public hospital in San Francisco. He tells stories of patients dealing with various ailments including testicular torsion, to a friend's uncle who was only able to walk on his knuckles, and a patient who was almost pronounced dead until he woke up following Dr. Schillinger's prayer. Dr. Schillinger expresses that "in the story lies the answers" but also shows how many doctors tend to not listen to these important stories, of which he is humble enough to say that he has also made this mistake. I would say the only negative of this great book, would be the tangents the author takes at times that seem to detract from his stories with verbosity. All in all, this was a fascinating account of the public health system and how it impacts those who receive care and provide care in this system.

Thank you to NetGalley and the publisher for access to this ARC!

[Christine Cazeneuve · Rating 4 out of 5]

I've always been drawn to books about medicine especially those that recount true tales. This book interested me as it was written by a doctor who worked in a public hospital. I enjoyed most of the stories but sometimes felt they were geared for those in the field. The author is a huge advocate of the war on diabetes and the latter part of the book dealt primarily with that. If you enjoy books of this type you will this as well. Thanks to Netgalley, the author and publishers for an advanced copy in exchange for my honest opinion.

[Nuzhat · Rating 3 out of 5]

I have mixed feelings about this book as public health is an interest and he has good stories to share about individual patients and how they reflect the injustices of life in these United States. I was surprised to see the tag of 'memoir' but it might make more sense as to why all his personal stories are also included, and it provides a stark contrast with his privilege compared to his patients.
I was glad that he brought up the nurse's discomfort of holding a patient down for a lumbar puncture that because of the emergent situation of the unknown he didn't need to have a consent from the unresponsive patient because I also felt that these vulnerable patients were being experimented upon as they came into the ER for the medical students and residents to practice their skills on.
I am forever frustrated that Coca-Cola and other multi-national companies have such influence on policy- generally despite their harm and cost. I really liked these chapters that focused on the struggle to prevent diabetes through initiatives that involved the community. Bringing in the teenagers to create poems about their neighborhoods and how diet and that unsafe environment were great strategies to increase awareness and appeal to those who could make a difference.

[Nancy · Rating 3 out of 5]

This book constantly went off the rails. I was expecting a narrative epidemiology to literally be the stories of the patients. Those that have been in the trenches of a bad health care system that kept them fighting for any scrap of help. Burdened by a public health care system that tries to make up for the larger well insured populace and hospitals with their shiny floors and new equipment; Dean-David Schillinger tries to tell the stories of those most effected by a myopic system.

When the author can stay focused and not branching off on his narcissistic “I” narratives, there are fascinating stories being told. The people and what their environments subject them to, tell a shocking, but then again, the reader shouldn’t be shocked, accounts of how poverty, skin color, lack of education, drug abuse, food deserts, and held captive at the whims of big business, dictate their lives.

Schillinger tried to put too many books into this one novel. Tell the public health story, tell the big business story, tell the holocaust story, just don’t tell them all within the same book all the while peppering the reader with your self-aggrandizing side stories.

[Zach Strassburger · Rating 4 out of 5]

Excellent book about the power of narrative in medicine. I really liked the patient stories and what he learned from each one. I got a little bored in the very long diabetes section—did we really need more than one poem from the students about sugar sweetened beverages in their communities? I think the author was so worried about leaving something or someone out that he lost his own narrator voice in parts. That said, really excellent overall and just a little too long. Highly recommended for anyone interested in medicine or public health. I can see a chapter or two as being a really valuable assignment in a sociology class, too.

Thanks to NetGalley and the publisher for a free early ebook in exchange for my honest review.

[Russell · Rating 4 out of 5]

"Telltale Hearts" charts the journey of the author, a public medicine doctor in San Francisco, as his career develops, interwoven with sections highlighting the importance of listening to the stories patients tell. Schillinger presents many instances of times when the medical tests and images were able to only tell part of the problems behind the sickness of his patients, and their verbal story was the key to understanding the underlying causes of their illnesses. Schillinger comes across as a most compassionate and caring physician. The best parts of the book are those with patient stories, the least interesting being his multi-chapter crusade against sugar-sweetened beverages in the Bay Area and their causal effect on diabetes in less affluent people of color in that region.

[Cheyenne · Rating 4 out of 5]

Thank you, NetGalley and PublicAffairs/Bold Type Books fur this advanced reader’s copy. As I work in medicine, I am drawn to personal experiences and stories from medicine and this book is no different. I greatly enjoyed this author’s personal story as well as all his patients stories told throughout the book as his journey working in internal medicine at San Francisco General. His continued pursuit to encourage public health and well-being showed in his career with care and the treatment of his patients. Thank you, Dr Schillinger for all your work and for sharing your stories and those of your patients.

[Diana Rivers · Rating 3 out of 5]

I'm not quite done but almost. I feel conflicted about this book. The patient stories are very interesting. However, like with so many memoirs or books like this one, the dialogue seems like it has to be fully imagined. It's quite stilted; a lot of the time when i read I think "no one talks like that!" And how could he remember it all unless he took notes of patients' every word bc he knew he'd eventually write a book? Also I've mostly read it in the middle of the night, so I've forgotten what I'm trying to say, but I remember thinking something about men/women being written about or treated differently in his anecdotes. But again this is a very poorly formed thought.

[Kathleen W.]

Book 365 for 2025

This book tells the story of the author who is the doctor, his training and his patients through the years in various places. Most of them have been poor people without other options than the public hospital. Some of them get medical care, follow directions and get better. Others have addictions and refuse to follow a treatment plan.

I only gave it *** because the patients all ran together and after a while it was hard to keep the details straight in my mind. I don't know if this was due to the story or if it was me.

[Ann · Rating 3 out of 5]

The stories were good. In other places the author got a little involved in his causes and went on a little too much for me. Sometimes the book was a little disjointed as he went back and forth from the medical stories to the description of his Hungarian father's experiences in the hands of the Germans in World War II. The last third of the book was primarily about his crusade to cut down on sugar in foods due to the proliferation of diabetes, primarily in the underserved areas where he works. That was not as interesting as the stories he told earlier.

[Nicole · Rating 4 out of 5]

This was an interesting book and I appreciated Dr. Schillinger sharing his patients' stories and his approach to medicine. In a time when many of our healthcare interactions take place while the physician is typing into an electronic medical record, these stories show how important it is for the physician to build rapport with, and truly listen to their patients.
That you NetGalley and the publisher for access to this ARC.

[Omm · Rating 4 out of 5]

Thoughtful exploration of narrative epidemiology. However, if you are expecting the tight stories of Every Patient Tells a Story or the like, seek elsewhere. There are some amazing stories but also deep dives into public health, science, and the author's own life experiences. For the most part this is positive and does not detract from the enjoyment although it does occasionally result in odd pacing.

[Daniel Grossman · Rating 5 out of 5]

Through the lens of his experience at SFGH, Dean-David Schillinger has woven together a series of gripping and heartwarming stories that form a tapestry depicting our health care system and our society generally. Schillinger writes with warmth, humility and deep insight, leaving the reader feeling that they’re in the examination room with him. I imagine that most readers will be afforded a wholly new angle from which to view and critique our society’s care for the least fortunate among us.

[Kathleen · Rating 3 out of 5]

I picked this book up only because the author is a friend of a friend. As a retire physician I find many of these “memoir” type books a little repetitive. I was disappointed in this one. The author’s focus is supposedly going to be on the importance of truly understanding the stories patients are telling as we provide care. But, for the first third of the book, Schillingst seems to be writing about himself, telling his own story. Bah!

[Carrie Maslow · Rating 5 out of 5]

Telltale Hearts is a riveting, inspiring book which I found impossible to put down. I read it in a day and was totally consumed with each patient's story. The writing is powerful, down-to-earth, honest, and accessible. The author certainly proves his point, that listening carefully to people's stories is the best way forward in improving public health.

[Aly · Rating 5 out of 5]

To a nurse and non-fiction lover this book was interesting from start to finish. His stories are captivating and Dr. Schillinger's ability to connect with and care for patients is inspiring. I walked away from this book truly wanting to be better.

[Rebecca S · Rating 5 out of 5]

I couldn’t put this book down. It was so beautifully written and an excellent primer on public health and social determinants of health told through incredibly engaging stories. It was a privilege to read about these peoples’ stories (and the author’s) and to learn from them.

[Karen · Rating 4 out of 5]

Eye-opening first-hand experience from a doctor with a heart and willingness to stay unjaded to the extent possible about our health care system.

[Sydney Jablonski · Rating 3 out of 5]

Work reading. Not a bad book by any means, and perhaps one that would have more shock value if I wasn’t already in healthcare.

[Susan]

Telltale Hearts by Dean-David Schillinger

[Bella · Rating 4 out of 5]

hi to all my heath sciences goodreads friends u should read this book

[Sawan Garde · Rating 4 out of 5]

not the best writing or organization, but great content. very affirming and inspiring.

[Allyson Dyar · Rating 4 out of 5]

Telltale Hearts: A Public Health Doctor, His Patients, and the Power of Story begins with Dr. Schillinger discussing his deep depression and how through therapy—specifically, his therapist encouraging him to tell the psychiatrist his story—that he not only was able to get out of his depression, but Dr Schillinger came away with a profound insight into his relationship with his patients.

Or, as he put it, “This book reveals what my patients have taught me that the combination of stories and science holds the key to recovery.” He called this epiphany “narrative epidemiology,” which he believed could transform health care.

He specifically mentioned the work that John Snow did back in England during the Nineteenth Century. Snow is considered the first epidemiologist for his work discovering the cause of the cholera outbreak in London and coming up with a simple explanation. His solution, after extensive investigations including talking to victims and those who had not been affected, he was able to discern why some were infected and those who were not. His solution was simple: remove the handle of the Broad Street Pump where most of the victim’s had gotten their water. As a result, the number of cholera cases declined.

With this set up in mind, I had expected that most of the book would be the stories of individual patients and how Dr. Schillinger was able to help them, and for the most part it was, but what I wasn’t expecting was a very detailed discussion of working on the problem of the rising number of diabetes cases in the community as a diabetes czar in California.

If I have any complaint about the book, it is the fact that his work as the diabetes czar takes up a good portion of his book and he wrote what I would deem to be unnecessary details. For instance, was it necessary to publish that many poems or his efforts in getting a sugar sweetened beverage tax to be placed on the ballot? I am sure there are those who would find all this quite interesting, but it took up a third of the book, which I felt detracted from the overall focus of the book.

I also found that some of his tangents, even when the patient narratives were fascinating, sometimes detracted from the overall enjoyment of the book because they really did not add all that much.

I would recommend this book to anyone who is interested in patient narratives, and I would also recommend this book to anyone who is interested in the public health system and how to go about making effective changes.

4/5 stars

[Thank you to NetGalley and the author for the advanced ebook copy in exchange for my honest and objective opinion, which I have given here.]

[Regina Matthews · Rating 4 out of 5]

Interesting stories told by a doctor and his experiences with his patients. I enjoyed this book until the end. He got too much into politics and diabetes. I lost interest in all of that. Otherwise, it was a very good book.