When Dr. Damon Tweedy attended Duke University Medical School, he was once asked to fix the light in a lecture hall. His professor, whom he calls Dr. Gale, assumed Tweedy was a janitor even though he was dressed in a polo shirt and khaki slacks. Weeks later, he met with Gale in his office. Tweedy had received the second highest score on his final exam and wanted to know if he met the cutoff for Honors. He did. But Gale couldn’t hide his astonishment at Tweedy’s accomplishment, nor did he apologize for mistaking him for a handyman.
Tweedy left Gale’s office “with a confused mixture of pride, relief, frustration and bitterness.”
“‘Are you here to fix the lights’ stirred then – and still today – each of those emotions.”
This sets the tone of Tweedy’s poignant journey from a medical student to a doctor in his frank memoir, “Black Man in A White Coat: A Doctor’s Reflections on Race and Medicine.”
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The son of a grocery store butcher and a federal government worker, Tweedy is constantly reminded of the color of his skin from fellow doctors, patients and the African-American community. He highlights the slights and assumptions about him and about African-American patients that often result in fatalities and disturbing outcomes for people of color.
He asks, “Why do black people suffer more health problems than other groups? What do these challenges mean in their everyday lives? How do their struggles play out before a largely white medical community? How can we begin to solve these seemingly intractable problems? Do I have a special role to play as a black physician?
The relationship between African-Americans and health care is complicated.
From the 40-year Tuskegee syphilis experiment, when the government let black men die from syphilis, to Henrietta Lacks, an African-American woman who unknowingly was the source of cells to create the first known human immortal cell line for medical research, blacks are often treated as maladies instead of people who deserve to be healed.
Tweedy confirms what so many African-American men and women feel when we go to the doctor: We’re not always getting the same care as whites. But his book also examines how we contribute to some of our own bad outcomes. He sees far too many pregnant teenagers, overweight African-American women and jobless black men with no health insurance.
He pulls back the curtain and reveals that when you don’t have health insurance, you are often prescribed medication that is affordable but not always the best treatment. And that often the white doctor sees your chronic condition as your fault.
For me, what makes Tweedy’s book required reading for African-Americans and health care professionals are the suggestions he offers on improving the outcome of all patients, no matter their means.
It’s clear that when Tweedy sees an overweight African-American woman with diabetes, he’s reminded of a grandmother or aunt with “sugar,” a phrase some older folks use to describe the chronic disease.
“It is up to us, as doctors, to find the commonalities and respect the differences between us and our patients. In the way, we can understand what they value, how best to communicate with them, and how to arrive at treatment plans that improve their health while respecting their wishes. This approach is often called cultural competence, but after years of medical practice, it seems to me more like common sense.”
Bridgette A. Lacy is the author of “Sunday Dinner,” by UNC Press
“Black Man in A White Coat: A Doctor’s Reflections on Race and Medicine”
Picador, 304 pages