A Doctor Reflects On Race And Medicine In 'Black Man In A White Coat'

Transcript

LINDA WERTHEIMER, HOST:

Dr. Damon Tweedy is a black man in a white coat. He's an African-American doctor. "Black Man In A White Coat" is what he's called his new book, "A Doctor's Reflections On Race And Medicine." Dr. Tweedy is a practicing psychiatrist and an assistant professor of psychiatry at Duke University Medical School, which is where he trained.

Dr. Tweedy, welcome to our program.

DAMON TWEEDY: Thank you.

WERTHEIMER: Very near the beginning of your book, you tell a story about your early days at Duke Medical School. At the very beginning, you were intimidated by big, bad Duke, so you said you studied very, very hard for the first round of exams, and you aced them. So then you arrive at your biggest class feeling very good about yourself. The professor calls you over and asks a question. What was the question?

TWEEDY: So I was coming into the classroom after a break and he comes up to me, somewhat angrily, and asks me about fixing the lights and that he called about this earlier and that I was late in my job. And so, clearly, this was a case of mistaken identity. And when I told him, you know, that I'm actually a student in his class, he looked at me very baffled, like someone was playing a joke on him, and just walked away. And so at the time, it was very hurtful and created a lot of self-doubt. You know, in some ways, looking back on it - it's nearly 20 years ago now - it's kind of amusing in a way because, as my wife can attest, I'm basically the most non-handy person around the house that you can imagine.

WERTHEIMER: (Laughter) No one would send you to fix any lights.

TWEEDY: (Laughter) Exactly. But the way that I really handled that situation, for me, was to really double down and prove to this professor - and really everyone else, in my own mind - that I belonged there.

WERTHEIMER: So what did you understand about that experience? Did you understand that you were perfectly capable of making it at Duke, or did you understand that you wanted to run screaming from the room and never come back to Duke?

TWEEDY: I think two things. I came from a very working-class background, parents to go to college. They didn't even finish high school. And so I was able to compete on the level with students whose parents were doctors, professors, and I could really hold my place there. But it also told me that race was something that was there and it wasn't just in my mind. It was something in the way other people would perceive me, so it was a challenge that I'd have to face.

WERTHEIMER: You also encountered conversations between patients and white doctors which you felt were tinged with racism. And you were pretty sure that the patients heard it and you heard it, but your colleagues didn't hear it. I'm thinking of a bunch of doctors gathered around the bed of a guy named Gary.

TWEEDY: Yes. Gary was a black gentleman in his mid-50s. He came to the hospital with chest pain, and they did several blood tests and other sorts of tests, and he didn't have a heart attack. And then we came to his room and the plan was to sort of go over what was next as far as his treatment. And in this particular case, he was pretty much on board with everything they recommended with one exception. They wanted to try him on a particular blood pressure medicine, which is actually very common in this setting.

However, he really wanted to try and work on his diet and exercise. And he said, I know what you guys are trying to do, and I know I need to do better. But their reaction was really curious because this was a public hospital setting and the patients there often did not follow the medical advice. And so I think there was a perception that they had that maybe there was something wrong with this guy if he knows all this information and he's thinking this way.

And so when we left the room, you know, he ultimately decided he wanted to wait on taking the medication until he tried to eat better and exercise and see how that worked first. The doctors started to speculate about what psychiatric illness he had. And it just sort of really took me aback. I'm - certainly - I'm a psychiatrist, so I certainly am well-experienced in dealing with people with mental illness and he seemed to have no signs whatsoever. So it was a really a stark example to me of how, you know, that sort of perceptions of what people can do really influences how doctors can, you know, in terms of their plans for the patients.

WERTHEIMER: You do say in the book - in fact, I think it's in the introduction - you say that one of the things you learned in medical school was that being black can be bad for your health. I mean, there's a whole series of chronic conditions that you saw over and over again. And, in fact, high blood pressure is a problem that you have, isn't that right?

TWEEDY: Yes, that's correct. I was diagnosed with it as a first-year medical student, so really that very first same time when I was learning about how so many of these diseases were more common in black people. So in the book, I talk quite a bit about how I was able to work through managing my high blood pressure. And now I'm at a point where I don't require medication or anything. I manage everything through nutrition and exercise.

WERTHEIMER: Like Gary.

TWEEDY: Yes, exactly, exactly. So he was certainly someone I could personally relate to. And so I was really taken aback that he would be given a psychiatric label for wanting to do what seemed the right thing to do.

WERTHEIMER: Did you feel then and do you feel now that you do have something unique to offer black patients? Or are you uncomfortable with the idea of having a special relationship?

TWEEDY: I think it's evolving and it's mixed. I mean, in some ways, I don't feel as if every black patient needs to have a black doctor. I don't think that that's the goal of our society. But, yes, at the same time there is a really bad history in terms of how African-Americans have been treated in the medical setting. And if you go back 50 years ago, you're talking about segregated wards. You're talking about experiments and surgeries being done without consent. And so I think there's some vestiges of mistrust.

What you see now, often, are patients who are being resistant to taking treatments that are actually the appropriate treatments, for instance, for things like diabetes or high blood pressure or depression. And you'll find patients - black patients - often feeling as if the care they're getting is somehow substandard when, in fact, it really isn't. But it really is based on that perception from history. And so I think as a black doctor, I've often been able to bridge that and sort of be a translator in a way. And I've, many times, been able to convince patients to follow what really are the appropriate standard of treatments.

WERTHEIMER: Dr. Tweedy, thank you very much.

TWEEDY: Thank you.

WERTHEIMER: Dr. Damon Tweedy's book is called "Black Man In A White Coat." Transcript provided by NPR, Copyright NPR.