This month, my International Bookish Club (maybe we’ll make a name) decided to do some independent study. We would each find a book, podcast, movie or other media on the topic of medicine as related to race/class or other intersectional topics. For my part, I checked out Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine by Damon Tweedy, M.D And Superior by Angela Saini. I started with the memoir and haven’t finished the latter.
I listened to the audio book of Black Man in a White Coat and took few notes. At first, I would stop but then decided it would be okay to speak in generalities when sharing my book with my bookies.
Studying at Duke University
Tweedy went to Duke on a full scholarship and attributes this to affirmative action and reparations. He discusses how universities vied for the best of the black doctors to meet quotas. With Duke being in the south, it wasn’t the first choice for many Black doctors.
Unsurprisingly, race comes up early in the book. Tweedy explores the role of race in getting into medical school and succeeding there. He notes that Black doctors disproportionately failed in school or in later exams to practice medicine. Perhaps that was due to a cultural disconnect or to them being accepted to the program as a result of affirmative action.
The cultural and racial disconnect is apparent. In this first year, a professor mistakes Tweedy for a maintenance person. When Tweedy explained that he was not in the classroom to fix the lights, the professor asked him why he was there. Dumas explains his sense of shame and how they drove him to get one of the best scores in his final for that course, thereby garnering some of the professor’s respect.
The Role of Race
When the professors brought up race in the classroom, and they often did, the statistics were damning. African Americans are more prone to a host of illnesses including hypertension, diabetes, heart disease, stroke. Being black was presented as a risk factor for many diseases; it was bad to be Black. Many of these statistics were new to me such as the risk of stroke being 3-4x higher in African-Americans than Whites. While Tweedy uses the terms Blacks and Whites in the book, this is clearly an American story.
I wonder if in Czech Republic my race factors prominently in my care. Tweedy wonders why race is part of the initial presentation that one doctor makes to the other for a patient. While gender and age are important for a person’s care, why is race considering that there are so few illnesses that are more prevalent to one race over another. What biases does this indicate and what might it be triggering?
Unequal Access to Healthcare
Recently during the televised superbowl, the number of medical ads was a surprise to European viewers. Amongst developed countries, America stands alone as the country that doesn’t provide universal health care. Tweedy illustrates how poor people and Black people are the victims of this system. Private medicine affords people better care while those on Medicaid, and particularly from poor communities, have limited access to health care and often received inferior care. Inferior care is often due to the prejudices of doctors and the inability for the patients to advocate for themselves. They often do not know enough to do so. Tweedy experiences both sides of the issue.
As a doctor, Tweedy sees and hears the prejudices of his colleagues and has to fight against his own. He discovers that he is in another cultural environment than the one he grew up with. Unlike some of his classmates, there is no legacy of medical education. No one else in his family is a doctor.
Tweedy has to challenge his own prejudices, recognizing the dangers in drawing assumptions from the physical attributes and dress of some of his patients. He is able to build relationships with White patients who are racist and those who initially distrusted him. He learns that personal relationships can transcend general stereotypes. While many of his patients have multiple jobs, they have no medical insurance. This challenges Tweedy’s notion that most people without healthcare are unemployed..
“Injustice in health is the most shocking and the most inhumane.”
Martin Luther King, 1966, as quoted in Black Man in a White Coat by Damon Tweedy
As a Black Man
As a Black man, Tweedy met both Black and White people who didn’t trust his knowledge and skills as a doctor. At other times, he met Black people who saw his skin color as a positive. As a patient with a White doctor who didn’t know him, he saw how brusquely the doctor treated him. This all changed when Tweedy revealed his medical training. Then, the doctor paid much more attention to him and his injury, looking him in the eye for the first time.
Tweedy suffered from high cholesterol and hypertension himself. He reflects on how his diet contributed to these struggles. More broadly, he suggests that the unhealthy diet of African Americans is a major contributor to their poor health. Combined with the lack of medical insurance and reduced access to medical care, the acceptance of larger bodies, and inferior care even when they have access, the increased incidents of medical crisis is no surprise to Tweedy..
Whether as a doctor or as a patient, interacting across racial lines is rife with opportunities for misengagement, illustrating the segregation that persists in medicine. Tweedy shows that connecting on a human to human level or a doctor to doctor level can remove some of the challenges. He acknowledges that some of the issues are systemic – race, class, socioeconomic factors playing big roles in access to medical care. Once there is access, the next challenge becomes institutional and personal racism and prejudice. He recognizes that the solution is multi-pronged.
Black Man in a White Coat
This book is not a deep dive into the issues affecting American society regarding medical care. Rather, it’s one doctor’s experience as a Black man from university to medical residency and practicing as a psychiatrist. In the course of the memoir, we learn that Dr. Tweedy is married and has at least one child. His wife is also a doctor. He speaks briefly of his family, of learning the colloquial language of medicine from them, but there are few other details of his life.
As the book ends, Tweedy has been a doctor for over seventeen years. It is 2013 and he recently attended a reunion for the medical school’s alumni. It was also a chance to honor the first Black doctor from Duke, who graduated in 1967, was honored there. Tweedy reflects on the contribution of this doctor, Merriweather, and how he paved the way for future Black doctors at Duke, including Tweedy.
As he visits the old clinics where he would sometimes work on weekends in disadvantaged neighborhoods, he realizes that there have been some improvements in medicine. The patients who attend this clinics receive more consistent care from the same doctor rather than having a different doctor serve the clinic each month. The facilities are also improved. The demographics, however, are the same, with most White medical staff and black patients.
Final Verdict on Black Man in a White Coat
I learned some specifics about the increased medical risks to African Americans. However, nothing else in this book was surprising to me. Tweedy speaks of being from the disadvantaged community whom he sometimes served. Yet, he recognizes his own prejudices about people from similar communities and his lack of understanding about their lives. He develops much of his understanding of people and the society he lives in through his experiences as a medical student and professional. In some ways, and at some points, he seems caught between the racial, social and cultural spaces in which he lives. He admits that he rarely took the opportunity when offered to directly work with and mentor upcoming Black doctors; he felt he was already doing enough for the communities he served.
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