Preferential Treatment: A Medical-Legal Novel

by William Parsons

West Virginia lawyer, Jack Fabian, is a battle-hardened, hard-drinking personal injury trial lawyer concentrating his practice in medical malpractice plaintiffs cases. Fabian, who has developed a penchant for big spending, expensive airplanes, top-shelf booze, and luxury vacations finds himself in 2005, feeling the adverse effects of the recently enacted repressive medical malpractice tort reform law in his state that has dulled his enthusiasm for the practice in general and plaintiffs malpractice law in particular. Through a series of unforeseen circumstances, Fabian reluctantly finds himself teamed up with former adversary, Benjamin Darnell, a recently deposed partner in a large insurance defense law firm and becomes embroiled in a case against a young neurosurgeon who, the two contend, botched his first surgery since completing training. Preferential Treatment is a story of two former foes pitted against the litigation sections chairman of Darnells old firm and his young associate in a case that could make or break each of their small practices. The book gives the reader a birds-eye view of the rough and tumble of the practice of law in a dying West Virginia town and the risks few lawyers dare to takethe difficult, time-consuming, and expensive practice of medical malpractice litigation.

367 pages, Kindle Edition

Published December 7, 2016

Reviews

[Darryl Greer · Rating 5 out of 5]

There are no evil assassins, no heart-thumping car chases, no superheroes trying to save the world and no spooks lurking in the shadows but "Preferential Treatment" is as fast-paced as you get. If you enjoy Robin Cook medical thrillers, you will love this book. If you enjoy John Grisham legal thrillers, you will love this book too. It is thrill ride from beginning to end but when the main trial gets under way, the pace really picks up and the pages run hot. It helps that the author, William Parsons, himself a seasoned specialist medical malpractice trial lawyer, describes every step in the case in some detail. It is clear that he has an incredible knowledge of complex surgical procedure. The story is well-structured, perhaps unsurprising for a lawyer and so vividly described that it is easy to picture every scene. The book is quite insightful, highlighting exactly what can go wrong in complicated surgery, even at the hands of medical personnel who appear to patients and their families as confident and self-assured. "Preferential Treatment" is a stunning debut novel and highly recommended.

[Eleanor Jansen · Rating 5 out of 5]

As someone fascinated by professional ethics, this novel felt like a case study disguised as fiction. The negotiations surrounding the neurosurgical malpractice claim are rendered with unnerving specificity, especially the moments where strategy overtakes empathy. Fabian’s calculations—about money, leverage, and timing—are chilling precisely because they’re plausible. The atmosphere inside conference rooms and deposition spaces is claustrophobic, thick with unspoken threats and performative civility. I was particularly struck by how the younger legal associate observes these maneuvers, absorbing lessons without commentary. The book doesn’t preach; it lets transactional logic speak for itself. While the legal detail may slow readers unfamiliar with malpractice law, I found it clarifying rather than overwhelming. This is a novel about systems more than heroes, and it succeeds by refusing to simplify them.

[Matthew Yancey · Rating 5 out of 5]

I came to this novel expecting the familiar rhythms of a courtroom thriller, but what I found instead was a quiet, unsettling study of professional burnout. Jack Fabian’s indulgent lifestyle—private flights, expensive liquor, reckless spending—registers less as bravado than as a kind of slow unraveling. A celebratory dinner meant to signal triumph lingers with an unexpected hollowness, its emptiness echoing long after the scene ends. The atmosphere throughout the book is tense and fatigued, as though success itself has begun to sour. What impressed me most was the absence of sentimentality; disillusionment is presented plainly, without apology or melodrama. Even victories carry the weight of exhaustion. Law, in this world, is neither heroic nor villainous—it simply grinds forward. The novel resonates because it doesn’t console the reader; it asks what, if anything, remains when ambition finally loses its shine.

[Addison Isherwood · Rating 5 out of 5]

What stayed with me most about Preferential Treatment was the mood—tight, smoky, and restless, like a courthouse hallway after hours. Jack Fabian isn’t introduced as someone to admire, yet his excesses feel inseparable from the legal world he inhabits. One scene involving his early-morning reckoning after a deposition captures the cost of living on adrenaline and alcohol. The alliance with Benjamin Darnell, forged after years of professional hostility, adds a brittle tension that never quite relaxes. Every exchange feels weighted with past grudges and present necessity. The West Virginia setting isn’t decorative; it presses in, shaping how justice is pursued and compromised. I read this during winter, and the book’s gray moral palette fit the season perfectly. It’s not comforting, but it’s honest about ambition, fatigue, and the quiet erosion of idealism.

[Mark Lanchester · Rating 5 out of 5]

The most impressive element of Preferential Treatment is its sense of place. The small-town legal ecosystem feels insular and unforgiving, where reputations linger and grudges calcify. A hospital emergency intake scene early in the book establishes an atmosphere of fluorescent-lit urgency that echoes later in legal proceedings. Medicine and law mirror each other here—both hierarchical, both defensive, both resistant to scrutiny. The novel handles professional confrontation with restraint, allowing tension to build through dialogue rather than spectacle. I also appreciated how the title quietly reframes itself as the story unfolds; “preferential treatment” applies far beyond the courtroom. This is not escapist fiction. It asks readers to sit with discomfort and ambiguity, and rewards those willing to do so.

[Chloe Pennington · Rating 5 out of 5]

This book feels timely in an era when institutions protect themselves first. The clash between plaintiff-side desperation and defense-side power plays is rendered without caricature. Benjamin Darnell’s fall from his former firm gives the story a sharp edge, especially in scenes where he navigates old loyalties while building something fragile and new. The atmosphere is one of constant calculation—every conversation feels like a chess move. I found myself admiring the author’s refusal to provide moral shortcuts. Nobody is fully right, nobody fully corrupt. The legal system emerges as a machine that rewards stamina more than virtue. If you’re interested in how professional alliances are forged under pressure, this book delivers with quiet intensity.

[Andrew Garcia · Rating 5 out of 5]

Reading this as a non-lawyer, I was surprised by how accessible the tension felt. The deposition sequences crackle with psychological warfare, even when the technical language gets dense. There’s a moment when a defense expert falters that changes the emotional temperature of the entire narrative; from that point on, the book hums with anticipation. The atmosphere is combative but controlled, like a storm contained indoors. I appreciated how the story acknowledges grief without exploiting it. Loss exists here as a legal fact, not a melodramatic device. The book trusts readers to connect the dots emotionally, which I respected.

[Arabella Clark · Rating 5 out of 5]

I read Preferential Treatment slowly, partly because it demands attention and partly because its tone is so deliberate. The legal negotiations unfold like endurance tests, not dramatic showdowns. Fabian’s interactions with insurance representatives are especially revealing—polite on the surface, ruthless underneath. The atmosphere reminded me of winter mornings in government buildings: quiet, cold, and consequential. This novel isn’t interested in catharsis. It’s interested in process, compromise, and the price of persistence. While some readers may wish for faster pacing, I found the restraint purposeful. It mirrors the grinding nature of the legal battles it depicts.

[Alfred Anderson · Rating 5 out of 5]

What surprised me was how much this book says about aging in high-pressure careers. Fabian’s physical weariness, his hangovers, his flashes of self-awareness—all contribute to an atmosphere of decline masked as confidence. A late-night reflection after a hard-fought legal victory reveals how success can feel strangely empty when repeated too often. The story doesn’t mock ambition, but it does interrogate it. I found this especially resonant during the holidays, when reflection tends to surface uninvited. The book asks whether professional wins can substitute for meaning, and doesn’t offer easy answers.

[Ashley Martin · Rating 5 out of 5]

This is a smart, unsentimental legal novel, though it occasionally leans too heavily on procedural detail. Certain stretches of negotiation may test the patience of readers looking for narrative momentum. That said, the atmosphere of institutional fatigue is exceptionally well-rendered. The courtroom-adjacent spaces—offices, conference rooms, hotel bars—become emotional pressure cookers. I admired how the book avoids turning malpractice into spectacle. Instead, it presents it as laborious, expensive, and morally complicated. While the pacing isn’t for everyone, the intellectual honesty kept me engaged.

[Anthony Jackson · Rating 5 out of 5]

The partnership between Fabian and Darnell is the book’s quiet engine. Their shared history injects every conversation with subtext, making even mundane exchanges feel loaded. There’s a scene involving a handshake agreement that feels more dangerous than any courtroom confrontation. The atmosphere throughout is transactional, but never sterile; personalities clash constantly. I was struck by how trust is portrayed as provisional and reversible. This book feels especially relevant now, when professional survival often depends on unlikely alliances. It’s sharp, controlled, and deeply observant.

[Candice Campbell · Rating 5 out of 5]

This novel captures the invisible labor behind high-stakes litigation. Long nights, financial risk, and emotional compartmentalization all seep into the atmosphere. One moment involving the calculation of case expenses made me pause; it reframed justice as something that must be financed before it can be argued. The book doesn’t glamorize this reality, and that’s its strength. It’s a sobering look at how access to accountability is shaped by resources. I finished the book feeling unsettled, which I suspect was the point.

[Keith Ellsworth · Rating 5 out of 5]

There’s a lot to admire here, particularly the authenticity of the legal environment. At times, however, the narrative risks narrowing its emotional range by staying so firmly inside professional viewpoints. Readers hoping for broader exploration of the human consequences may find that aspect understated. Still, the atmosphere of moral fatigue is consistent and convincing. The book feels less like a thriller and more like an autopsy of ambition. That won’t appeal to everyone, but it’s a deliberate choice.

[Carol Murray · Rating 5 out of 5]

I was drawn in by the title and stayed for the moral ambiguity. The idea of “preferential treatment” extends to geography, profession, and perception. Certain characters benefit from assumptions baked into the system, and the novel lets those advantages operate quietly. The atmosphere is restrained but tense, like a conversation where everyone knows more than they’re saying. I appreciated how the book resists tidy conclusions. It reflects a world where outcomes are negotiated, not earned.

[Terry Frasier · Rating 5 out of 5]

This book reminded me why legal thrillers can be intellectually gripping rather than flashy. The tension comes from leverage, not violence. A negotiation scene hinging on timing rather than evidence was particularly effective. The atmosphere is controlled, almost clinical, which makes the ethical slippage more disturbing. I admired how the author trusts silence and implication. It’s a book that respects the reader’s intelligence.

[Faith Smith · Rating 5 out of 5]

Preferential Treatment is dense, deliberate, and unapologetically procedural. That density may deter casual readers, but it also gives the book its authority. The atmosphere is one of constant pressure, where every decision carries financial and reputational risk. While some character arcs remain emotionally distant, the thematic cohesion is strong. This is a novel for readers who appreciate realism over reassurance. It lingers not because of shock, but because of recognition.