The Last Should Be First

What does American health care demonstrate about who we honor most, and who we leave behind?

What if medicine isn't just about treating illness but about revealing what a society values?

In The Last Should Be First, psychiatrist and physician leader Arthur Lazarus delivers a sharp, unflinching collection of essays that exposes the moral contradictions at the heart of American health care. This is not a policy book. It is a reckoning.

Through gripping reflection and cultural insight, Lazarus shows how a system designed to care for the vulnerable often does the opposite by rewarding efficiency over humanity, confidence over truth, and process over people.
Inside, you'll discover:

• Why patients often become the evidence of failures that were long predicted
• What happens when treatment becomes coerced
• How professional standards can quietly turn into punishment
• The hidden risks of artificial intelligence in medical practice
• What medicine loses when struggle, uncertainty, and judgment are replaced by speed and automation
• How influence, titles, and digital authority can outpace real expertise
• Why the exam room is increasingly shaped by politics, not patients
• What today's system asks of physicians, and whether the next generation should accept it