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A doctor’s memoir shows race matters in the hospital room

September 15, 2015 at 6:10 PM EST
In medical school, Dr. Damon Tweedy says he learned about health problems being more common in the black community, but he didn’t hear the reasons why. In “Black Man in a White Coat,” Tweedy examines racial disparities in medicine, for both patients and medical professionals.
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GWEN IFILL: Infant mortality, life expectancy, heart disease, obesity, in almost every area of health outcomes, black people are more vulnerable.

In the latest addition to the NewsHour Bookshelf, one African-American doctor talks about what that looks like from the inside.

Jeff is back with that.

JEFFREY BROWN: Being black can be bad for your health.

It’s a lesson Damon Tweedy writes in his new book, “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine,” that he learned time and again in his own life and in his many years as a doctor. Tweedy is a psychiatrist at Duke University, where he also attended medical school.

And welcome to you.

DR. DAMON TWEEDY, Author, Black Man in a White Coat: Thank you.

JEFFREY BROWN: So, you start with this big subject. Is that what started it for you, that you wanted to write about?

DR. DAMON TWEEDY: Yes.

So, race is this really highly charged political subject that we have in our society, obviously, but, for me, this is a very personal story. This is really kind of about my experience and my journey.

All too often in medical school, you learn about health problems in the black community, you learn — you hear this disease is more common than this. It’s always more common in black people, but you didn’t really hear why. And so it wasn’t — and the question of why is a huge issue for me.

And there was also a big question about how my experience as a young black man was different than the experiences of other people in my class.

JEFFREY BROWN: Well, that comes through, because you’re also saying that, as a young doctor in training, you’re saying constantly hearing about the medical frailties of black people picked at the scab of your insecurity. You didn’t set out thinking about medicine and race.

DR. DAMON TWEEDY: No, I was actually attracted to medicine.

It was sort of like this — it was almost like a post-racial kind of mind-set I had. Medicine to me held it appeal to being objective, formulas, equations. And it was really — and that was appealing. So much of society is messy, and life is messy as a black person. So this — it was this appeal that it could be objective.

And then, when I got to medical school, I kind of got a rude awakening that it wasn’t.

JEFFREY BROWN:
When you refer to your insecurities, what do you mean?

DR. DAMON TWEEDY: I come from Prince George’s County, Maryland. And it was an all-black neighborhood that I grew up in, just outside of Washington, D.C.

And I went to a state college. Then I got to Duke. Duke is a fancy private school. A lot of my classmates had parents who were doctors. And so I was really insecure about that.

And as a black person, there is always a sort of thing about, is affirmative action part of why you’re here, and do you really belong? And so I grappling with all those things when I first got to medical school.

JEFFREY BROWN: You write about a number of incidents that you witnessed in which you saw white doctors unaware of the different ways that they were treating black patients.

How much in the end did you conclude that race does a play factor in the doctor’s room, in the hospital room?

DR. DAMON TWEEDY: I think it plays a big factor, and often in ways that the doctor and the patient may not even be aware of.

And there are several examples I talk about in the book. And there is one example in particular, so it comes to mind off the top of my head. This was a time when I was going to the clinic myself as a patient. So, I’m coming from home. And I had injured my knee a few days earlier.

And I’m dressed very casually in sweatpants and a sweatshirt. And I come into the exam room with the doctor. And he comes in. And he never looks at me. He just looks at my knee and sort of has me stand up and down and then says, you’re OK, and kind of was going to shuttle me away.

And being a doctor, I knew that there was more that could be done or should have been done. And so I mentioned to him that I’m a doctor. And then, suddenly, he looks at me, and his eyes kind of light up. And he looks at my knee. He starts to talk to me. And so he really engages in the sort of doctor-patient exchange, the way that it should have been from the beginning.

And it was a really vivid illustration of how differently I can — perceived. On one hand, I could just be a young black man who is off the street somewhere. And who knows what negative presumptions he may have had, because he didn’t engage with me at all. And then once he realizes I’m a doctor, it was like a totally different experience.

And so I think that really illustrates how differently things can play out in the exam room.

JEFFREY BROWN:
You became a psychiatrist.

DR. DAMON TWEEDY: Yes.

JEFFREY BROWN: Why?

DR. DAMON TWEEDY: Great question.

I never thought, when I went to medical school, I would become — come to psychiatry.

JEFFREY BROWN: Yes.

DR. DAMON TWEEDY: But as I got towards the end of medical school, I took this one rotation just on a flyer, and I really enjoyed it. And the patients told my supervisors that I had a way with — of relaxing people and getting them to talk to me and I had a way of connecting with people.

And so that really made me think about psychiatry. There is also this huge issue as an African-American. And the mental health in the black community is really a big deal, because, often, black people will be resistant to mental health care or feel like it’s something that’s not for them. And there is this huge sort of stigma that we often deal with.

And so, as a psychiatrist, I have often been one of the only few black psychiatrist. And so it’s a huge deal there as well.

JEFFREY BROWN: Well, this is something important that you have written a lot about, the dearth of the black doctors generally.

DR. DAMON TWEEDY: Yes. Yes.

JEFFREY BROWN: And you’re pointing to that as one of the important factors of why blacks fair so poorly in the medical system.

Why? Why is it important to have more black doctors?

DR. DAMON TWEEDY: Yes.

So, African-Americans make up about 13 percent of the population, but about 4 percent of physicians. And it’s like — mental health and psychiatry, it is about the same, really low numbers.

And what you often see is that there is this issue of the patients don’t trust the health care system because there has been a bad history of things that have happened in the past. And so often, as a black doctor, I’m there to help sort of be a translator in a way.

JEFFREY BROWN: So that’s why we need more black doctors.

At the same time, I saw recently the Association of American Medical Colleges, a new report that applications from African-American men have declined…

DR. DAMON TWEEDY: Yes, exactly.

JEFFREY BROWN: … from 1978 to recently.

DR. DAMON TWEEDY: Right. Exactly.

JEFFREY BROWN: Why?

DR. DAMON TWEEDY: Yes.

So, the numbers for black women have actually increased during that time.

But I think there’s this bigger issue about the way society from the very top down kind of limits the horizons and the expectations of what African-American men can be. And I think that really filters down. It starts from the top and it filters down into the communities.

I come from that kind of community, where the idea of being a doctor was sort of an alien concept. And it was only the — I had the good fortune of having an older brother who had gone to college and then being in a program — I tested into a program that really set — a magnet program that really set me on that path.

But there all too many young black men who don’t have those opportunities. And there is talent being squandered. And so I think that is the big factor.

JEFFREY BROWN: I know this is a sort of personal memoir for you.

DR. DAMON TWEEDY: Sure.

JEFFREY BROWN:
Have you thought about larger questions of policy-type questions of what should be done, either in the medical profession or the wider society?

DR. DAMON TWEEDY: Sure.

And in the book, I talk about some of those. I talk about the Affordable Care Act and its — the way it’s helped and the way it’s been undercut by sort of the politics of all of it.

I also talk about ways in which doctors and patients can be — can sort of be educated to have a better relationship, because I think that’s — a huge issue in my book is about the doctor and patient relationship. And when that’s frayed, that really makes a huge impact on patients. And, ultimately, the way our society is set up, often, black people are the ones who are facing the biggest consequence for that.

JEFFREY BROWN: All right.

The new book is “Black Man in a White Coat.”

Dr. Damon Tweedy, thank you so much.

DR. DAMON TWEEDY: Thank you, sir.

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