Review by New York Times Review
ON AVERAGE, black women can expect to live three years less than white women; the difference between black and white men is nearly five years. These and other racial disparities led Damon Tweedy to announce in his memoir, "Black Man in a White Coat," what many of us already knew: "Being black can be bad for your health." This is an inescapable fact, especially when you consider the following people and circumstances surrounding their deaths: Kathryn Johnston, Tarika Wilson, Trayvon Martin, Eric Garner, Michael Brown, Tamir Rice, Walter Scott and Freddie Gray. It seems strange that none of them are mentioned in this book. But Tweedy isn't an expert on race. He is a Duke-trained psychiatrist with an interest in closing health disparity gaps. "I hope to contribute," he writes, "to a much-needed public dialogue on improving the health of black people." Through the lens of his personal journey, Tweedy discusses issues of race and medicine from the perspective of both patient and physician. This is an engaging approach. The book contains multiple scenes during which the reader eagerly awaits the patient's diagnosis and outcome. There are sad but humorous bits too. Black and a towering 6 feet 6 inches tall, Tweedy was sometimes mistaken for a Duke basketball player. "How on earth do you balance your hospital schedule," the wife of one patient inquired, "with all your games and practices?" He grew up in a working-class Maryland suburb just outside Washington. Despite having been accepted into schools with more name recognition, he chose to attend a local state college because it offered the benefits of a full scholarship and an opportunity, well yes, to play Division I basketball. We learn that these apparent advantages conspired to increase Tweedy's insecurities when he entered medical school surrounded by predominantly white classmates coming from elite private schools. Throughout the book, his intense fear of being labeled a "racial victim" or exposed for what he viewed as inadequacies is palpable. His honesty is praiseworthy. On the other hand, his unwillingness to call out medical malpractice and blatant racial discrimination is disappointing if not blameworthy. The chapter titled "When Doctors Discriminate" describes the case of Gary, a 55-year-old black male admitted for chest pain. Tweedy, a recently minted physician, is asked to complete the discharge orders. Having previously examined this patient, he is quite familiar with the case and is horrified to see that Gary has been given an additional diagnosis of obsessive-compulsive personality disorder. A senior white physician made this diagnosis after Gary declined to take a medication prescribed for hypertension as recommended by this doctor. Instead, Gary chose to alter his diet and exercise more, a decision viewed as oppositional by the white physician. Tweedy thought Gary's response was appropriate. He certainly didn't think Gary's assertion of agency was an indication of an obsessive-compulsive disorder. Still, rather than voicing his view, Tweedy discharged Gary without altering the misdiagnosis. His insecurities and fears about being labeled too sensitive or a "difficult" person paralyzed him. There are other occasions during which Tweedy chose not to act in the face of racial inappropriateness or discrimination. But, to be fair, in most incidents, he was a medical student, and as he observes, "Learning to be a doctor was hard enough without my trying to change the whole system too." Although expressing one's view about inappropriate behaviors can hardly be interpreted as trying to change the entire system, it is understandable that Tweedy might have felt intimidated and uncomfortable challenging his superiors. But now, several years removed from being a trainee, it's dismaying that he does not provide a deeper or more meaningful self-evaluation. The book falters most when it ventures into areas that are beyond Tweedy's expertise. Medical anecdotes are used to bemoan and explain high rates of teenage pregnancy, homicide and incarceration among blacks. In all cases, there is virtually no contextualization provided that would indicate the complicated factors - mostly nonmedical - contributing to these disparities. Tweedy particularly emphasizes the fact that the teenage pregnancy rate is twice as high among blacks as whites, while barely noting that rates for all groups have steadily dropped over the past 25 years. The decline among black teenagers has been the steepest, but this is not mentioned at all. Teenage pregnancy rates vary widely from state to state, with teenagers in rural counties at greater risk. The complexity of the issue cannot be fully appreciated when the focus is limited to black and white. It's nearly impossible to have a discussion about the homicide of a black person without being told that black people are more likely to be killed by other black people. Tweedy reminds us of this, even though all Americans are much more likely to be killed by a member of their own race. And while the book draws attention to extraordinarily high incarceration rates of blacks, it was particularly disappointing that there was not a discussion of racially discriminatory policing in the war on drugs or in other domains. Blacks are far more likely to be arrested for drugs than whites, even though they use drugs at rates lower than or equal to whites. The reader is left with the impression that all Americans have an equal chance of being incarcerated. In one of the more distressing scenes, Tweedy accompanies paramedics to an Atlanta housing project, which allows him to perpetuate the misguided notion that these residences are largely black and violent (the good folks who live in public housing in Wyoming, Vermont and other heavily white states might have something to say about this). In an effort to describe the dangers faced by paramedics, the book practically suggests that medical personnel should be armed with weapons or bulletproof vests, like police officers. There is no consideration given to the different roles played by different actors, or to the fact that most residents do display respect and humanity. Elsewhere, Tweedy describes a gripping E.R. scene, where he is assisting in the care of Leslie, a black 19-year-old pregnant woman in medical crisis. Before the night is over, her fetus has died and we learn that Leslie smoked crack cocaine just two days before. The reader is led to believe that smoking cocaine caused the death, even though little other information is given about the environment in which the fetus was developing. It would be important to know, for instance, something about Leslie's nutrition habits, whether she had received prenatal care or whether she used other drugs, including alcohol, nicotine or caffeine. Most people recognize that cocaine use - as well as other drug use, poor dietary habits, lack of exercise - during pregnancy should be discouraged. The problem here is that the focus is limited to cocaine. This narrow view is reminiscent of attitudes in the late 1980s and '90s when there was widespread fear that prenatal crack exposure would produce a generation of damaged children. The scientific evidence never supported these concerns. But, as a result of alarmist claims, children were removed from their mothers and laws were enacted permitting the arrest of pregnant women and new mothers - outcomes shown to produce harmful effects on children. The aim of "Black Man in a White Coat" is an important and admirable one. It calls further attention to racial health disparities. Unfortunately, Tweedy's superficial thinking will no doubt limit his book's impact. Tweedy discusses race and medicine from the perspective of both patient and physician. CARL HART is a professor of psychology at Columbia and a visiting research scientist at the Brocher Foundation in Geneva.
Copyright (c) The New York Times Company [September 6, 2015]
Review by Booklist Review
*Starred Review* Tweedy, an African American psychiatrist at Duke University, expertly weaves together statistics, personal anecdotes, and patient stories to explain why being black can be bad for your health. The son of a grocery-store meat cutter, Tweedy grew up in a working-class neighborhood and attended Duke on a full scholarship, where he faced prejudice from some white patients and medical-school professors (one doesn't realize he is a student and asks him to fix the lights in the lecture hall). But he also runs across less-than-welcoming African Americans, including one patient who says, Go tell your boss I don't want no black doctor. . . . I could have stayed home if I wanted to see a country ass doctor. Tweedy organizes his story into three themes. Under disparities, he says that blacks represent 13 percent of the U.S. population but only 7 percent of medical students and that black men are 7 percent more likely than white ones to get a diagnosis of HIV. In barriers, he notes that some doctors assume black patients are poorly educated, drug abusing, and less likely to comply with treatments. And in perseverance, he calls for improving access to quality medical care and getting African Americans to address unhealthy behaviors that contribute to their higher rates of obesity and hypertension. In all, a smart, thought-provoking, frontline look at race and medicine.--Springen, Karen Copyright 2015 Booklist
From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Publisher's Weekly Review
In this eye-opening memoir, Tweedy, a black psychiatrist who interned at Duke University Medical School in the mid-1990s, vigorously confronts his profession and its erratic treatment of African-American patients. Tweedy, raised in a segregated working-class neighborhood, gets a full scholarship to the white academic world of Duke, where he's challenged on every level, including by a professor who wrongly assumes he's a janitor. Though Duke, like many elite colleges, tried to recruit minority students, Tweedy notes that the constant subliminal and overt racism at the school-which former professor Henry Louis Gates Jr. termed "the Plantation"-caused many non-white recruits to suffer self-doubt and anxiety. His painful anecdotes, both as an intern and physician, show the critical health crisis within the black community; his patients included a drug-addicted girl pregnant with a dead infant, an older woman suffering from high blood pressure and diabetes, a man struggling with mental illness, and a young woman who contracted AIDS from her boyfriend. Tweedy nicely unravels the essential issues of race, prejudice, class, mortality, treatment, and American medicine without blinking or polite excuses. (Sept.) © Copyright PWxyz, LLC. All rights reserved.
(c) Copyright PWxyz, LLC. All rights reserved
Review by Library Journal Review
In this memoir, physician Tweedy (psychiatry, Duke Univ. Medical Sch.) shares his life at different stages in the medical profession, discusses how race affects his experiences, and explains the health challenges affecting black communities. Tweedy comes across as a caring individual and represents the health professions in a positive light. His comments will make listeners think about how they can work to improve the situations of all. Read ably by Corey Allen, the work is written in short episodes ideal for listening on the go. Verdict Highly recommended for all interested in health disparities, health education, and minority issues in medicine. ["A must-read for anyone interested in improving medical care, from training to delivery in a world where race persists as a factor in life and death": LJ 7/15 review of the Picador hc.]-Eric Albright, Tufts Univ. Health Sciences Lib., Boston © Copyright 2016. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review
An arresting memoir that personalizes the enduring racial divide in contemporary American medicine. When North Carolina physician and psychiatry professor Tweedy first entered Duke University Medical School as one of only six black students on a full-tuition scholarship, he was already well-aware of the vast health disparities between black and white populations, where lack of insurance and "poverty topped the list of culprits." Throughout grueling years of intensive schooling and patient care, the doctor repeatedly pondered his role as a black physician in a predominantly white medical community. Tweedy devotes equal time to his academic term in medical school, to a yearlong clinical apprenticeship where he swiftly became "consumed by the broader health problems of my race," and to his former psychiatry practice. Early on in his career at Duke, his resolve was tested when a professor mistook him for a janitor, yet he remained committed. Tweedy's tenure throughout his hospital internship forms the memoir's riveting centerpiece. Structured around fast-paced, eye-opening medical cases encountered on clinical rotations, many episodes are tainted with the stigma of social, racial, and economically charged misconceptions and biases. The author includes anecdotes featuring prejudiced patients and discriminatory doctors as well as one about a longtime-married Christian man's shocking HIV seroconversion. Tweedy also shares his own battles with inherited kidney disorders and hypertension along with lucid thoughts on a physician's obligation to community health and the liberating power of tolerance. Clearly at odds with the racial and class-stratified machinations of the medical industry, the author writes with dignified authority on the imbalances in opportunities and available social and medical service platforms to the many African-American patients seeking clinical care and of his pivotal role in making a difference. In this unsparingly honest chronicle, Tweedy cohesively illuminates the experiences of black doctors and black patients and reiterates the need for improved understanding of racial differences within global medical communities. Copyright Kirkus Reviews, used with permission.
Copyright (c) Kirkus Reviews, used with permission.
