In his memoir and debut book, Dr. Damon Tweedy, an assistant professor of psychiatry at Duke University Medical Center and practicing physician, follows the old adage “write what you know.” Previously, he has written on the topic of race and medicine in journals read by those in the medical field, but by offering his story to the public he expands his audience and helps to enlighten readers on topics not often discussed within the realm of medicine, even in today’s climate of civil rights and racial justice.
The world of medicine has been intriguing to those outside the system for decades, and authors such as Michael Crichton or books such as Samuel Shem’s fictionalized account, “The House of God,” have been capturing the public’s attention for decades. Tweedy’s account is different in many ways, mostly because he tackles the issue of race in medicine.
In the interest of full disclosure, I am also a physician in training, completing my residency in family medicine in Seattle after completing medical school here. Thus, I cannot read this book like a lay person, but I can appreciate the accounts he details as well as testifying to the
urgency of addressing issues.
“Black Man in a White Coat” is divided into three sections entitled ‘Disparities,’ ‘Barriers’ and ‘Perseverance.’ While these topics are addressed throughout the book, the themes allow for a focus within the otherwise chronological telling of Tweedy’s story. As with many memoirs from physicians, these themes are elevated through the patient stories he highlights. While the book clearly builds on itself, in some ways each chapter could be taken as a stand alone, with its own point and subject matter.
In the chapter “People Like Us,” Tweedy discusses his experience as one of the few Black students at Duke in the context of similar experiences of students around the country. He makes the political personal with his descriptions of discrimination as well as the issue of affirmative action.
As he progresses through his medical training and enters the clinical years, where one begins working with patients, he details the injustices of the system and its racial discrimination. Tweedy offers nuanced reflections that allow the reader to see how he processes experiences. In the chapter “Charity Care,” a two-tiered health system for those with and those without— a division that often falls along racial lines — becomes increasingly obvious to the young medical student. His experience is not unique, but often goes without discussion throughout medical training in my experience. It is noteworthy that this book addresses this injustice and how it persists in a system that is lauded for being so advanced.
One of the most powerful anecdotes is Tweedy’s experience with a patient named Chester. Chester and his family were blatantly racially prejudiced and focused their hate and ignorance in their language and their expressed desire for different physicians. Tweedy decides to persevere in this environment to develop a genuine human connection with them in their time of need. It is a heroic encounter with a humanistic analysis. Because this is something that happens regularly, it is at very least fuel for further discussion.
I personally enjoyed the chapter “When Doctors Discriminate” because it calls to task medical professionals for contributing to disparities or inequities themselves. The anecdotes he shares illustrate large problem that he summarizes, “Doctors, like all other people, are capable of prejudice and discrimination. While bias can be a problem in any profession, in medicine, the stakes are much greater.”
Throughout the book Tweedy discusses his own health battles — a sprained knee and hypertension — which offers more insight into the ways in which he processes and experiences both medicine and race. The book’s bibliography does the same, and allows readers to continue the journey beyond his memoir.
My criticisms of the book are in lock-step with my criticism of what we are taught in medical training: That racial disparities or inequities have anything to do with biology is to say that race has a biological foundation instead of a social construction. The tug and pull of personal versus societal responsibility for so-called health behaviors, such as diet and exercise, and the consequences of those views, are things that Tweedy and I will perhaps have to agree to disagree about.
The end is optimistic, reflecting on how and where he started and how far the medical education system has come with regard to representation. He also revisits many of his old medical school haunts to discover hope and committed leaders as well as ongoing challenges.
This book is a required read for not only those of us in medicine, but also for patients, advocates and activists alike. It would also make for an interesting book club choice. Finally, I’m sure it has already been gifted to many current and future medical professionals, and I would advocate for it to be given to many more.
Who: Author, Dr. Damon Tweedy
Where: Seattle Public Library
When: Friday, Feb. 26, 2016, at 7 p.m. for an author reading.