Randall Kennedy is the Michael R. Klein Professor of Law at Harvard Law School.
During his first year at Duke Medical School, Damon Tweedy returned to a lecture hall after a mid-class break only to be confronted by the professor, who asked, “Are you here to fix the lights?” Tweedy was taken aback as the professor explained with some irritation that he had called the previous week about the dim lighting on one side of the hall. Tweedy fumbled to reply, saying, “I don’t have anything to do with that,” prompting the professor to demand, “Then what are you doing here in my class?” Tweedy told him the simple truth: “I’m a student . . . in your class.” The professor huffed, “Oh,” and then walked away.
Tweedy’s encounter with the professor was an early lesson in his experience as an African American in the medical profession, a tale he evocatively recounts in “Black Man in a White Coat.” Duke aggressively recruited Tweedy, an alumnus of the University of Maryland Baltimore County and a man with working-class roots whose parents had not attended college. Duke Medical School wanted desperately to increase its number of black students to atone for its blatantly racist exclusionary history. (It did not graduate its first black student until 1967.) The school also wanted to seed the profession with black physicians, who presumably would be more inclined than white doctors to serve black communities in dire need of accessible health care. To advance its mission, Duke awarded Tweedy a full scholarship.
Duke was interested in Tweedy because he was a member of a small cadre of black candidates whose grades and test scores suggested an ability to survive the rigors of an elite medical school. In various ways, however, Duke accentuated Tweedy’s feelings of marginality, anxiety and insecurity. That insensitive professor, Tweedy writes, “shattered my brittle confidence and my tenuous feeling of belonging at Duke.” But instead of letting the incident ruin him or complaining to school administrators, Tweedy resolved to disprove all negative preconceptions about his abilities. “I studied my ass off,” he remembers with pride, earning a final grade that surprised himself and the professor.
When Tweedy became a doctor, he treated an array of patient crises, including a stillbirth, an unexpected diagnosis of HIV, an utterly debilitating stroke and devastating mental illnesses. His patients are predominantly black, and most convey pride in his credentials and abilities. A few, however, immediately suspect that he is inferior to his white peers. An African American man suffering from sickle-cell anemia objects when he realizes that he has been assigned to Tweedy. “C’mon man, we both know what the deal is,” the patient tells Tweedy. “I’m sure you did good in school and everything, but they’re passing you off on me. And they think that I won’t care because I’m supposed to be a dumb [n-----]. Go tell your boss I don’t want no black doctor.”
Tweedy confronts similar skepticism from whites. He recounts an instance in which a “seventy-something white guy” showing signs of major infection arrives at an emergency room and announces loudly, “I don’t want no [n-----] doctor.” In this instance, as in the case of the man with sickle-cell anemia, Tweedy disregarded the insults, quietly established his authority and compassionately rendered care that eased distress — care that both patients came to acknowledge.
A recurrent message in Tweedy’s memoir is that the health of black Americans is far worse than that of whites. Infant mortality among blacks is twice as high as among whites. Hypertension is about 50 percent more common among blacks than whites. Black people are 50 percent more likely than whites to be obese. Blacks are more than eight times as likely as whites to be diagnosed with HIV and are about nine times more likely to die from AIDS. “Being black,” Tweedy notes, “can be bad for your health.”
The causes are numerous and deep-seated, and unlikely to be uprooted anytime soon. Tweedy stresses the economic plight of blacks: Their lower incomes prevent them from purchasing adequate health care, even after the passage of the Affordable Care Act. He offers one example after another of individuals forced to postpone or skip getting treatment or medicine because they simply can’t afford it. He cites unhealthy cultural habits, particularly bad nutrition, that contribute to poor health. He notes, for example, that many blacks continue to eat unhealthy soul food despite warnings to avoid it, and that some — even educated, affluent African Americans like himself — reject a more healthful lifestyle of proper nutrition, exercise and the avoidance of toxins because of the perceptions that this would constitute a kind of racial betrayal. Tweedy also blames blacks’ poor health on discrimination by doctors who make invidious assumptions and devaluations similar to what blacks confront in dealings with merchants, teachers, politicians and police.
“Black Man in a White Coat” offers a clear, informative and uncommonly balanced assessment. Tweedy unflinchingly examines historical patterns of racial inequity in health care. He also brings attention to often-overlooked indicators of progress. With respect to recipients of health care, he notes the striking recent gains in the longevity of black males. With respect to providers of health care, he highlights the opportunities that he has enjoyed. He is an assistant professor of psychiatry at Duke University Medical Center and a staff physician at the Durham VA Medical Center. “Back in 1996,” he recalls, “I had been racially and culturally insecure, afraid that Duke would be too much for me and that I would fail; by 2013, I was a faculty member who comfortably supervised and counseled medical students and residents of all racial and cultural backgrounds.”
Though racism remains a baleful presence in medicine as elsewhere, Tweedy acknowledges that the Duke Medical School that once rejected black talent now rewards it. Two years after he graduated, a black physician was appointed as chair of Duke’s department of obstetrics and gynecology, while another black physician was appointed as chair of its famed department of surgery. A few months ago, a black physician was appointed chief executive of the Duke University Health System. Attentive to the frustrating inequalities rooted in our history, Tweedy’s “Black Man in a White Coat” is also usefully attuned to the promising prospects ahead.