The DO Book Club, April 2022: Black Man in a White Coat

Welcome back to The DO Book Club! This month, I reviewed Black Man in a White Coat by Damon Tweedy, MD (Picador, 2015, 294 pp.).

While Dr. Tweedy was working hard and applying himself to the study of medicine at Duke University School of Medicine in North Carolina, he struggled with his own health and the health care of many of his Black patients. His memoir examines the complexities of being a Black person training as a physician and a Black patient in a system fraught with cultural, social and economic inequities.

A hurtful mistake

Early on while at Duke, an incident in which one of his professors mistakes him for a maintenance man shakes up the young author. He feels the weight of affirmative action policies and representing his race on his shoulders. He reflected on the proud “blue collar” careers of his father and grandmother.

Dr. Tweedy writes, “What bothered me was Dr. Gale’s assumption that I had no business in his class unless I arrived in some service capacity. Sensitive as I already was about my place at Duke, this incident stabbed at the core of my insecurity. With one question, Dr. Gale had shattered my brittle confidence and my tenuous feeling of belonging at Duke.” (pp. 14)

When he hears the morbidity and mortality statistics of Black men and women, who are more impacted by health care disparities and thus tend to have worse health outcomes than whites, Dr. Tweedy takes on those numbers as insults.

His rotation through a rural health clinic in North Carolina brought home many of the health care disparities inherent in a system that depends on people having health insurance through employment.

Troubling inequities

Dr. Tweedy had always assumed that the uninsured were also unemployed. He saw many working people who delayed treatment and could not afford the expensive medications that he saw dispensed at University Hospital in Durham, North Carolina. These inequities troubled him greatly.

During an OB-GYN rotation, Dr. Tweedy helps treat Leslie, a pregnant 19-year-old who habitually uses crack cocaine. Leslie undergoes a heartbreaking late-second-trimester episode of fetal demise and subsequent delivery of her dead baby. He notes the animosity of the veteran white labor and delivery nurse, Carla, who judges Leslie quite harshly.

Dr. Tweedy confesses, “And, if I had to be honest with myself, I too felt disdain toward Leslie, perhaps on some visceral level, even more powerfully than Carla did. As a crack-abusing pregnant woman, Leslie had put the worst face of Black America on full display for this white medical audience.

“Much of my life had been devoted to combating and defeating vicious racial stereotypes. But in witnessing the pathology of Leslie’s behavior and the doctor’s and nurse’s reaction to it, I suddenly felt naked, as if someone had stripped me of my white coat and left both of us to share the same degrading spotlight.” (pp. 41)

Lessons learned

Dr. Tweedy shares one particularly affecting incident that occurred during his internship year at Duke University Hospital after a patient announces, rather bluntly, that he doesn’t want a Black physician to take care of him. Of course, inevitably Dr. Tweedy cares for the man and must confront the malignant racism of the patient and his family. 

He works extra hard to overcome his own aversion toward the patient and to give them no reason to find fault with his care. Somehow both parties in this encounter learn a valuable lesson from each other.

Much to his own dismay, Dr. Tweedy also discovered that he held many of the same assumptions and biases as his white colleagues. 

In a chapter about HIV/AIDS and race, the author reviews the grim statistics regarding the prevalence of the disease: “Black people in the U.S. are more than eight times as likely as whites to be diagnosed with HIV. Once diagnosed, they are about nine times more likely to die from AIDS. Hispanic patients are also afflicted in disproportionate numbers. What was once seen as a white disease has turned Black and brown.” (pp. 155)

Dr. Tweedy finds that many Black patients come from a strong homophobic culture and are therefore too afraid to be truthful with their partners about their sex practices, which leads to the spreading of HIV.

Dr. Tweedy admitted that he also held many of those same homophobic biases and needed to address them in himself. He also noted that he observed many of the same racial and cultural biases held among whites were just as strong within the people of color he was treating. 

For example, some Black patients preferred not to be assigned to a Black doctor. Additionally, the author found himself being quite judgmental when he was assigned to care for a white man who came from an entirely different background than himself.

Highly recommended for DOs

Osteopathic physicians should most certainly put this book on their reading list. Dr. Tweedy covers many issues by introducing his very honest brand of personal reflection and curiosity. His research on cultural and racial biases is extensive, yet written in a way that all readers will easily understand.

Dr. Tweedy goes on to become a psychiatrist; in the book, he also discusses the considerable racial disparities in the realm of mental health treatment.

Dr. Tweedy’s recounting of an ambulance ride-along in the rough neighborhoods of Atlanta reminded me of my ride-along experience as a resident with paramedics in West Philadelphia. That ride into a different world opens up the eyes to see things neither Dr. Tweedy nor I could ever imagine. Awareness must be the start of understanding.

This is not just another medical memoir. This is a beautifully written volume on the struggles of one Black man navigating medicine and a thorough explanation of the many issues people of color face when seeking treatment.

Our country has made many gains in the areas of civil rights and equal opportunities, but there is still quite a long way to go. If you want to be an anti-racist and an ally, a better understanding of these issues is a paramount first step.

May’s book

For May, Daniel J. Waters, DO, MA, will review The English Patient by Michael Ondaatje, Flying Blind: Boeing’s Max Tragedy and the Lost Soul of an American Icon by Peter Robison, and Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare by Niran Al-Agba, MD, and Rebekah Bernard, MD.

We encourage all who are interested to read along (this book club can be followed at any pace)! If you are unable to get out to a local library or bookstore, we recommend checking out eBook options.

If you read Black Man in a White Coat or any previous Book Club selection and want to share your reflections, please leave a comment below or email rraymond@osteopathic.org.

Related reading:

The DO Book Club, March 2022: Heartsounds, Echoes of Heartsounds, Changing How We Think About Difficult Patients

The DO Book Club, Feb. 2022: It’s All in the Delivery and Motherhood, Medicine & Me