Black health requires dose of medical humanity

I just read “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine,” a book that revolves around the idea that being a black American is bad for your health.

Every day the news bears that out. Wednesday it was a story saying the federal government estimates one in two black gay/bisexual men in the U.S. will be diagnosed with HIV, versus fewer than one in 11 white gay/bisexual men. Name the malady and the news for black folks likely will be bleak.

Dr. Damon Tweedy, the author, puts himself, society and the medical profession on a couch, then asks questions that stir up layers of complexity in the interaction of patient responsibility, poverty, culture, racial bias and institutional barriers to equal care. Dr. Tweedy tells stories from his life and career to help explore all of those factors, but he mostly leaves it to readers to find their way to answers.

That last part has to do with his self-effacing personality and perhaps the fact that he is a psychiatrist. He is an assistant professor of psychiatry at Duke University Medical Center and a staff physician at the Durham VA Medical Center.

He’ll be speaking Friday night at the downtown Seattle Central Library, so I called to talk with him about the book.

I appreciated the candid way he wrestles with his own complicated feelings about racial issues, but sometimes his internal questioning made it hard for me to see where he stood and why he was writing the book.

Tweedy told me he didn’t want to write a book that just preached to the choir, but rather to engage people who might otherwise not be interested in the subject or empathetic. And he wanted to do it without making those readers feel bad or guilty.

Tweedy grew up in a black, lower-middle-class neighborhood in a Maryland suburb of D.C. He writes about looking around a classroom at Duke wondering how he was chosen, given the elite schools his fellow white students had attended, and he concluded it had to be affirmative action. And despite doing well, he kept wondering if he really was good enough.

The medical school wanted to produce more black doctors, a highly underrepresented group, and in his book he writes about times when he thinks being black made a positive difference for a patient, and times when it didn’t seem to matter.

Tweedy tells stories about seeing white doctors discount black patients, especially poor ones, but also about times when he made negative judgments about black patients.

He writes about staffing a clinic with a group of white doctors treating poor, black people who had no other access to health care and seeing those doctors do all they could to help, while being frustrated by the structure of medical care. They could send their better-off patients to specialists, or prescribe expensive medications for them, but none of that was possible for the people at the clinic.

He writes about overwhelmed big-city hospitals where young, mostly white doctors-in-training practice their skills on the bodies of poor, mostly black patients before moving on to practice in better conditions.

Every aspect of medicine seemed to be affected by race and class. He injured his knee one weekend and, still wearing sweatpants, went to a clinic to have it examined. The doctor never made eye contact, never touched the knee, just looked at it and told him it would be fine.

When Tweedy told him about a previous injury and used medical terms to describe it, the doctor looked at him for the first time and asked if he was a medical person. Tweedy said he was a physician, and everything changed. The doctor did a thorough exam and even ordered an X-ray. Did race have anything to do with that? Class? Who knows, but no person should have to have that question hanging over their health care.

Would a black doctor have treated him better? Maybe. But, what would be best would be for all doctors to treat every patient like a person, to take a minute to understand something about that person beyond symptoms.

Books by doctors seem to be having a moment, and often they focus on the need to improve the human side of medicine. Doing that wouldn’t heal all health-care problems, but it would be a huge step in that direction. That’s one thing I take away from my time inside a physician’s head.