Black Man in a White Coat is a non-fiction book that follows along the story of Dr. Damon Tweedy as he looks back at his journey in becoming the doctor he is today. Dr. Tweedy is a Black man who reflects on his experiences and analyzes how racism has integrated into medicine and the healthcare field. His story begins in the early-to-mid 2000s discussing his formative days in Medical School at Duke University in North Carolina. As his story in medicine continues, he highlights different aspects of his journey and how racism has impacted him as a Black doctor as well as Black patients around him (including him as a Black patient at certain points). As the two newest PreHealth advisors to Northeastern, Emily and Tyler, we took some time this semester to read this book and delve deeper into issues surrounding racism within the healthcare field. Two themes throughout the book that we find Dr. Tweedy continuously referring back to are disparities within healthcare and representation within healthcare.
Theme 1: Disparities
One of the central themes in Black Man in a White Coat, is Dr. Tweedy’s encounters with both the health and health-care disparities of the Black community. Hypertension and other health problems more common in the Black community can be traced all the way back to the roots of American racism. Dr. Tweedy says, “Evolutionary scientists theorize that among African slaves, the ones best able to retain water survived the harsh Atlantic journey, passing on their genes, which later proved problematic in the modern world. Public-health writers comment on the various inequities in our health care system and cultural differences in dietary and physical activity patterns” (p. 72). Dr. Tweedy notes in his book that socioeconomic status and upbringing/environment largely perpetuate the medical conditions afflicting Black people. Dr. Tweedy recounts the stories of patient encounters he has had who have heartbreaking tales of failed pregnancy due to drug abuse, heart attacks brought on by the news of imprisoned family members, and lack of healthcare stemming from a lack of health insurance. As a student at Duke, Dr. Tweedy treated patients in a rural community clinic where patients relied on free samples of medication that he and the other medical students and doctors happened to have available. Patients are shuffled to different hospitals and receive disjointed, infrequent care solely because they do not have the health insurance needed to be treated with consistency. Dr. Tweedy expresses his heartbreak and confusion as he watches these patients in need simply fall through the cracks of the American healthcare system. As the reader, you can’t help but feel heartbroken as we read through Dr. Tweedy’s accounts, and wonder how and where those patients are now.
Theme 2: Representation
A second central theme in Black Man in a White Coat, is representation in the healthcare field. The issue of representation was discovered very early on by Dr. Tweedy as he started Medical School at Duke University. Because there were so few Black medical students at Duke at the time, Dr. Tweedy shared that he would at times feel like he stood out in school, not only due to race, but because many of his fellow classmates came from wealthy, privileged private school backgrounds. Prior to attending Duke, Dr. Tweedy graduated from the University of Maryland – Baltimore County, a public school in Maryland. It was during one of his courses at Duke where all students were excused to take their usual break in the middle of class and Dr. Tweedy reentered the classroom when he experienced an unforgettable moment. As he reentered the classroom, his professor approached him asking, “Are you here to fix the lights?” (p. 12). Dr. Tweedy replied with a no and was practically frozen at what just happened. When questioned why he was in the classroom by his professor, he responded that he was a student in his class and with no acknowledgement at what just occurred, the professor walked away. Along with a lot of his classmates not looking like him, this comment really opened Dr. Tweedy’s eyes to the lack of representation in medical school alone. His own professor did not even think he belonged there. This caused Dr. Tweedy’s own questioning if he should be there with fears he had and opened up a different conversation around the idea of affirmative action. Dr. Tweedy discussed the arguments of both sides of affirmative action in relation to medical school admissions. He talked about how while affirmative action can help Black students with admissions to schools, it does not always set them up for success once they arrive. It was also discussed that classroom-based performance does not always indicate the performance of a physician, but that was hard for him to think about as he saw that two of the three students that had to repeat their first year of medical schools were Black. At a clinic that Dr. Tweedy worked at, with a high percentage of Black patients, there was often positive surprised reactions from the patients when they saw Dr. Tweedy, being that most of the doctors they were accustomed to seeing were white. While this was the case back in the early-to-mid 2000s, it begs the question: has this changed since then? You can see from this AAMC resource the breakdown on race and representation of physicians as of 2018 here. Of all active physicians, as of 2018, 5% identified as Black or African American (AAMC).
Reading Black Man in a White Coat I believe was crucial, not just to my job as a PreHealth advisor, but as a human. It opened my eyes to more than just learning about the deeper understanding of disparities faced in the Black community in the healthcare field, but the importance of taking action to prevent future harm and establishment of equity. It doesn’t start simply at the healthcare profession, or even medical schools – it goes a lot deeper than that, where so many factors and areas need to be looked at to see the full picture. With the Black community at higher risks for various health conditions, to hear that only 5% of physicians identify as Black is very alarming. Dr. Tweedy demonstrated, that not so long ago and still carries on through today, the implicit and even sometimes explicit racism that Black physicians and Black patients face. As Dr. Tweedy took you on his medical journey, you experienced his emotions with him. While I cannot experience and feel the same exact things he has gone through, it hurts to see that this is just one story of many. Representation in the medical field is so important to the future of healthcare and is a step of many toward eliminating the disparities the Black community faces. Proper equity needs to be established in the healthcare field and it takes all of us to do it.
I’ve really enjoyed reading Black Man in a White Coat. Reading it gave me a deeper appreciation for the level of pressure and obstacles that Black medical students face that other medical students do not. The sobering statistic that only 5% of physicians in the US are Black, is a testament to the lack of representation in medicine. I can only imagine the pressure and weight of responsibility that Black medical students feel to be sitting in a classroom of people who don’t look like them, to ultimately make a difference in their communities and the world. Dr. Tweedy’s recount of his time as a medical student, doctor, and patient himself impacted me deeply. Reading his self-reflection and watching him become more self-aware throughout the pages of his book, encouraged me to do the same. Unless health disparities and lack of representation impact you directly, it is easy to pretend that they do not exist. But as Martin Luther King Jr. said, “injustice anywhere is a threat to justice everywhere.” The responsibility needs to be on all of us to strive for a world where there is diversity in the medical community, and where healthcare is not a privilege for some, but is accessible for all.
Continue the Conversation
We encourage you, especially if you’ve felt particularly compelled by what you’ve read, that you continue the conversation and continue to educate yourself and your community. The organization, Black Men in White Coats (separate from Dr. Tweedy’s book), seeks to increase the number of Black physicians through advocacy, working with medical schools, organizing youth summits, the creation of a documentary series, and more. Northeastern aired a viewing of the Black Men in White Coats documentary earlier this semester. We encourage all students, if you did not have a chance to view the documentary, that you visit the organization’s website (HERE) to learn more about their mission. We also encourage you to continue! Dr. Tweedy references another book in his, called Living and Dying in Brick City by Dr. Sampson Davis. In the book, Dr. Davis recounts his story of growing up in Newark and becoming a doctor, and the challenges and feelings he faced along the way.
by Tyler Rock and Emily Hyde