In the Gaps: Better Understanding the Expensive Human Suffering of Chronic Homelessness

by Brian Klausner MD

Why is the growing crisis of chronic homelessness, and its associated cost, so misunderstood and mismanaged?

If there was ever a time to address the chronically unhoused and bridge the gap between our ideals and actions, it is now. Drawing on years of experience caring for homeless populations, public health physician Brian Klausner, MD, shares the profoundly human stories hiding behind the statistics, weaving powerful accounts of resilience, childhood trauma, and its lasting effects into a bold examination of a preventable tragedy—one that drains taxpayer dollars, polarizes communities, and costs lives.

This thought-provoking and compassionate book challenges us to confront reflexive biases and rethink our approach to homelessness. Klausner delivers a science-backed call to action, urging us to unite around shared values and build a more humane, effective society.

Within In the Gaps, you'll

Strategies to understand chronic homelessness, the roots of trauma, and the solutions grounded in our shared ideals and values.Insights into the personal and financial toll of suffering and the systemic failures of American healthcare to address its associated poor outcomes.Tools to overcome reflexive dehumanization and align with our true individual, familial, and spiritual values.Ways to resist societal polarization in media and politics that distract from shared principles and goals.Recent neurobiological findings on trauma's impact on the brain, our predisposition to dehumanization, and how to cultivate empathy.How millions of Americans—both in healthcare and beyond—can unite around a common goal, and more.
In the Gaps is a thought-provoking dive into how we can collectively shift our culture. If you like enlightening conversations, being challenged for the greater good, and scientific exposition, then you’ll love Brian Klausner’s in-depth and inspirational message.

338 pages, Kindle Edition

Published December 3, 2024

Reviews

[Claire Middleton · Rating 4 out of 5]

Truthfully I had never thought about medical care for unhoused people before reading this book and I feel ashamed for the assumptions and stereotypes I’ve held about a group of people I haven’t put the effort in to understand. Apologies to my orthopedic surgeons and plastic docs, but this is certainly a book that makes you want to go into medicine for the compassion. Probably the best thing to read before your sanity and kindness melt away from 18 months of Foundation Phase Anki cards. A bit repetitive throughout but drove the main points home. With a little editing, an essential read for the humanistic approach to medicine

[Betsy · Rating 5 out of 5]

This book is geared towards people who work in medicine, but holds truths that everyone in the world (esp America) need to hear.

I have had a tangled relationship with my feelings about the homeless population, swinging from pity to compassion to frustration to resentment to ambivalence. Dr Klausner’s voice cuts through all those messy feelings, and provides clarity on why it is that I (we) struggle with compassion for those who wander inconveniently in our midst. More importantly, he poses the question- can we afford to allow this suffering to continue?

Spoiler alert, no.

If you’re interested in learning more about yourself and your own brain, read this book. If you’re interested in better caring for people who are homeless, read this book. If you’re interested in saving taxpayer dollars and addressing the expensive problems of the American healthcare system, read this book. If you don’t know what the heck to do about any of it, read this book. It’s not a to-do manual, but it’s an informative, researched piece that will help you (and me) better understand the why and the how, which is where any good critical thinking must start.

[Jane EGS · Rating 5 out of 5]

Imagine if we could provide medical care for our chronically homeless neighbors which is compassionate and efficient! Dr Klausner brings us along with him as he discovers the resilience and strengths of his patients and the inefficiencies of the medical system designed to treat them. Klausner is a good storyteller who interweaves his experiences with just enough facts and with intriguing explanations of relevant knowledge of how the body works. The book unpacks the complexity of the medical system (especially how it is funded) while also offering practical and efficient ways forward which are being tried and tested in the clinics where he works. I picked up the book at the urging of a friend and expected to be depressed and a bit bored; instead I found Klausner's writing engaging and his suggestions energizing. More, I find that this book has transformed how I react when I encounter homeless people in my day-to-day and has given me ways to think about and vote on local funding, as well as how I prioritize charitable donations.

[Jacob Callaway · Rating 5 out of 5]

This book was fantastic. I was especially impressed with Dr. Klausner’s story telling abilities. He was able to convey such strong emotions that stuck with the reader through stories that are very difficult to tell, all while painting the characters in an uplifting, positive light. His story telling ability really gives this book an optimistic tone that shines through the grim field of homeless medicine. Dr. Klausner also dives into problems in our health insurance and reimbursement structures and does a fantastic job at offering a bipartisan, humans first solution. Finally, Dr. Klausner deftly incorporates religious themes of love and compassion that are synonymous in many of the major religions today, finishing this book with a powerful message of love over hate and expanding his target audience further than just healthcare professionals.

[Anna · Rating 5 out of 5]

This was my required reading for UNC SOM and I genuinely enjoyed exploring the topic of homelessness and medicine. It touches on themes of healthcare infrastructure, humanization, empathy and love. A great reminder that we go into medicine not to treat symptoms, but to look for the mechanisms causing problems. To treat each individual with kindness and compassion.

[Nicole Meyer · Rating 4 out of 5]

Very interesting book to read as someone working in shelters in Raleigh and in municipal government. Especially interesting considering the current political contexts and stressors we are operating under. Much of this book was incredibly timely considering many state and federal decisions pertaining to homelessness and unsheltered policy.

[Annie Pugh · Rating 5 out of 5]

This inspirational book chronicled Dr. Klausner’s journey to treat the most vulnerable population. Really highlights how our medical system leaves this population behind and encourages us to fight to decrease suffering and end the cycle of homelessness.

[Susan · Rating 5 out of 5]

A valuable look at homelessness and how policies impact it from a local doctor. I was heartened to know that Wake County is doing more about this than I thought, and inspired by his emphasis on love and humility in helping people in crisis.