From the mid-1940s until 1972, as part of the infamous Tuskeegee study, the US Public Health Service deliberately withheld penicillin from hundreds of black men with syphilis so researchers could observe the natural course of the disease. During the Jim Crow era, many American hospital wards, blood banks, and even morgues were designated “White” and “Colored.”
Today, in what some call a post-racial society, African-Americans are more likely than whites to have diabetes, stroke, heart disease, prostate cancer, and HIV, and less likely to receive state-of-the-art treatment for these and many other serious conditions. Infant mortality is higher and life expectancy shorter among blacks than among whites.
In “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine,’’ Damon Tweedy, a psychiatrist at Duke, explores the reasons these disparities persist: racial bias, poverty, reduced access to medical care, and a shortage of doctors from minority communities. Tweedy offers stories from his own life and medical practice and an abundance of depressing data in support of his contention that “being black can be bad for your health.”
The son of a grocery-store meat cutter, Tweedy arrived at Duke in 1996 as one of few African-American medical students. While attending one of his first classes, a white professor mistook Tweedy for a maintenance worker and asked him to fix the lights.
Tweedy internalized this humiliation, faulting himself for not looking “the part of the preppy first-year medical student” and vowing to work hard to earn his professor’s respect. He remembers with obvious pain that the incident “shattered my brittle confidence and my tenuous feeling of belonging at Duke.”
Tweedy’s vulnerability makes him a vivid and engaging narrator. As we follow him from medical school through residency to his early years as a psychiatrist, he shares information both embarrassing and endearing: He binges on junk food, even after being diagnosed with hypertensive kidney disease, to which African-Americans are especially prone. He’s awkward and squeamish, a late bloomer regarding sex. He sometimes harbors his own racist thoughts about patients — white and black.
Like many memoirs by physicians, including Atul Gawande’s recent bestseller “Being Mortal,’’ Tweedy moves back and forth between anecdote and analysis. His account of treating a pregnant black teenager leads to a discourse on high pregnancy rates among black teens, for instance. His admirable goal is “to humanize the dire statistics . . . and paint a fuller picture of the experiences of black patients, as well as that of black doctors.”
Unfortunately, when switching from the personal to the general, the forthright Tweedy often seems to turn his pen over to a timid alter ego. After relating movingly his complex feelings about being admitted to Duke despite scoring lower on the MCAT than many of his white classmates, he offers this bland summary: “Depending on your perspective, affirmative action had done its job, giving a working-class black kid the chance for an elite education, or affirmative action had reared its ugly head, taking a slot from someone else more deserving.”
Similarly, he decries the “two-tiered system,” where blacks are less likely than whites to have private insurance and thus access to quality mental health care, but stops short of mentioning the single-payer option, or any other proposed reforms.
In fact, Tweedy expresses few opinions at all about how to eliminate racial disparities in health care. His inclusion of quotes by conservatives such as Dr. Ben Carson and Justice Clarence Thomas, and his emphasis on “poor decisions” as causes of obesity, drug addiction, and sexually transmitted disease seem to hint at his political leanings. But Tweedy is so diffident in discussing policy that it’s hard to tell what he really thinks.
One issue about which Tweedy does take a clear stand is the need for more black doctors. He argues convincingly that addressing the current underrepresentation of blacks in medicine — only
five percent of American doctors are black, while African-Americans make up 13 percent of the population — would improve health care for
Though less incisive than it might have been, “Black Man in a White Coat’’ still makes an important contribution to the ongoing debate about health care in America. Tweedy has advanced a much-needed public conversation about racial disparities in medicine which, while less familiar to most Americans than the deaths that inspired the Black Lives Matter movement, continue to cost black lives.
BLACK MAN IN A WHITE COAT: A Doctor’s Reflections on Race and Medicine
By Damon Tweedy
Picador, 294 pp., $26
Suzanne Koven is a primary care physician and writer in residence in the Division of General Internal Medicine at MGH. Contact her at www.suzannekovenmd.com.