At least once a day during my rotations, my race would come up in an interaction with [white] patients. The racial conversation was usually implied, rather than explicit….
—Damon Tweedy, MD
Title: Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine
Author: Damon Tweedy, MD
Publisher: Picador, Macmillan Publishing
Publication date: September 8, 2015
Price: $26.00; hardcover, 304 pages
Strained race relations over issues whose foundation is based on inequality remain a persistently difficult social problem. Inequality in health care has palpable social consequences. As Martin Luther King, Jr famously said, “Of all forms of inequality, injustice in health is the most shocking and the most inhumane.”
ASCO, for one, has been at the forefront of engaging the challenges associated with disparities of cancer care among economically challenged populations. These are complicated issues, with no simple solution in sight. However, our ability to make the U.S. health-care system more equitable relies, in part, on our insight into the social phenomena that create disparities.
In his recently published memoir, Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine, Damon Tweedy, MD, takes the reader inside the personal experiences of an African American’s journey into the medical profession, some of which are uncomfortable to read.
A Must-Read Introduction
Dr. Tweedy received his medical degree from the prestigious Duke University School of Medicine, “as one of a half dozen black students on scholarship.” As a psychiatrist, he brings the introspection of a discipline centered on the inner workings of the human mind to the pages of his thoroughly honest book.
Dr. Tweedy’s introduction is a must read. In economic prose, he lets the reader know exactly where he is coming from—make no mistake, this book is about race. And, according to the author, during his early medical schooling, the subject was thrust on him. His original goal was to make his parents proud and set himself up for a good career. In fact, race-based concerns were low on his priority list.
He writes, “But my professors could not stop talking about race. During my early months, as they taught us about diseases both common and rare, they inevitably cited the demographics about one racial group or another…. They spoke about Asians, Hispanics, and Native Americans, but invariably, as it always seems in America, their analyses always came down to comparing blacks and whites.”
Then it gets personal. “Each time demographics of a new disease came up in lecture, my stomach twisted. I knew where this was heading. Seated in a sea of mostly white and Asian faces, I wondered how this information affected their views of black people, whether they already had biases against us, and whether they impacted the way they saw me.”
In a very straightforward manner, Dr. Tweedy lets the reader know that even though he was a well-educated person studying to be a doctor at one of the nation’s most honored medical schools, he suffered insecurities based on his race. And in doing that, he tacitly renders a more somber picture of the health-care system he is about to join: If he, an African American doctor, is inhibited by a system that largely does not look like him, what chance does a poor, undereducated black person have in accessing equitable care? This question, in various permutations, is central to our ongoing health-care debate.
However, a book about medical care needs more than one conflict or argument to properly fill its pages and keep an audience like the readers of The ASCO Post engaged. To that end, with a few exceptions, Dr. Tweedy succeeds and does so admirably.
Different Phases of Medical Life
Smartly, he divided his book into three sections, corresponding to the different phases of his medical life. Giving a complicated set of subjects a modular framework results in a pleasant-to-read symmetry. Part 1 examines Dr. Tweedy’s medical school years; part 2, looks at the grueling 12 months of medical internship as a newly minted doctor; and section 3 gives a rolling overview of his years in psychiatry training and early clinical practice.
Part 1, titled “Disparities,” has a reader-friendly narrative style that livens up Dr. Tweedy’s serious arguments about disparities of care. Although illustrating the larger point of inequality with anecdotal stories from his medical school years—including his own compelling health drama with hypertension—linking multiple case histories runs the risk of becoming episodic. And here, Dr. Tweedy flirts with that danger.
It is well documented that poverty is the biggest predictor of poor health-care outcomes, and although Dr. Tweedy does elucidate real access issues faced by poor patients, he tends to blame the medical system’s inherent racism for the woes of economically challenged African Americans. Burdened as it is with fiscal troubles, however, the health-care system cannot overcome what is essentially a socioeconomic problem.
Section 2, titled “Barriers,” is where Dr. Tweedy vents his frustration with what he deems our system’s underlying race problem. If what he related were not true, it would sound like crude clichés. As he writes, “At least once a day during my rotations, my race would come up in an interaction with [white] patients. The racial conversation was usually implied, rather than explicit…. One person after another, usually white, took one look at me, being a tall black man, and inquired about my basketball skills…. Others offered advice, ‘your wasting your time in school. You should be playing in the NBA.’”
As astoundingly ignorant as these comments are, Dr. Tweedy perhaps goes overboard in relating one moronic comment after another. He then says, “Nor were stereotypes restricted to the South…. Otis Brawley has recounted similar experiences of patient and family prejudice.”
Dr. Tweedy recounts experiences that are bruising to read and often difficult to endure. He highlights the problems in a very humanistic manner, but he offers no solutions. This is a memoir after all.
In the final section, “Perseverance,” Dr. Tweedy offers his most balanced and reasoned exposition about race and medicine. Broken into several chapters, he ends with a cogent chapter called, “Beyond Race,” in which he deconstructs the Affordable Care Act, pros and cons, and gives the reader a physician’s take on how it affects overall health-care outcomes.
Black Man in a White Coat is an unvarnished look at what it means to be black in medicine. Most doctors are white. Perhaps more black doctors would make our health system better for all Americans. It is something to strive for, and Dr. Tweedy’s fine, well-written book speaks eloquently to the issue. ■