Sunday, January 31, 2016

Dr. Tweedy shares his discovery that he also matters

I assumed Dr. Damon Tweedy's Black Man in a White Coat: A Doctor's Reflections on Race and Medicine would be interesting; I didn't expect that it would be gripping and that I'd love it. Yes -- this is a memoir. But it is also an unstinting examination of how the US health non-system works and doesn't, told through an engaging story of personal education and evolution.

Medical school at Duke was unsurprisingly harrowing for Tweedy, a first generation college graduate from an unheralded public university, attending on an affirmative action scholarship. It didn't help his equilibrium when a professor assumed the only reason he could be in the classroom was to repair the light fixtures. Being the brilliant achiever he seems to have been, he aced the class and med school.

Subsequent medical education introduced him to a series of patients and circumstances that illustrate how our medical system fails black patients. There was the black, drug-addicted, young mother whose baby died stillborn -- and for whom there was no possibility of drug or psychological treatment because she lacked insurance. There were the black, rural, clinic patients who could no more afford drugs or obtain treatment for high blood pressure than fly. There were the black, urban, emergency room patients who never saw a doctor until their medical problems overwhelmed their bodies beyond what any doctor could offer them.

Beginning practice as an intern and later a resident, he learned to deal with patients, white and a few black, who didn't "want no nigger doctor."

No matter our successes that led us to medical school or our achievements there, it seemed some segment of the population would never fully recognize us. The insults didn't stop once you became a doctor. ...Nor were these stereotypes restricted to the South. [A researcher of these incidents] concluded that the pervasive nature of the negative race-related experiences leads to "racial fatigue" that contributes to higher rates of job dissatisfaction and greater changes in career trajectory among black physicians. ...

Tweedy recounts the dismissive treatment by senior white doctors of a black patient who insisted that, rather than take a prescribed blood pressure medicine, he'd try weight loss and exercise first. For resisting their authority, the patient left the hospital with a psychiatric diagnosis. He also describes, subtly and gently, occasions when being a black doctor for black patients unleashed patient insecurities that meshed and clashed with his own.

The chapter which completely drew me in is called "Doing the Right Thing." After discussing the many black patients he sees whose accumulated stress, bad diets and cultural conditioning nudge them toward early onset diabetes and heart disease, he discusses in detail his own struggle to maintain a healthy weight, exercise program and blood pressure. He learned from his patients.

Why was making long-term healthy change so difficult?

... it's hard to change patterns formed in childhood, perhaps even more so among blacks. ..."Soul food," especially popular in the South where the largest number of black people reside, tends to contain large amounts of red meat, added fats and salts, and is often deep fried. ... I believe the problem runs deeper than simply the food choices themselves. ... surveys indicated that black people are more accepting of -- and in some cases indicate a preference for -- heavier body types. Skinniness is more likely to be seen as a sign of illness ...

I embraced some of these ideas. Despite being a physician, I still viewed some aspects of healthy living -- eating salads, drinking water, going to a yoga class or jogging on a treadmill -- with disdain. ...I had internalized such behavior as the domain of perfectionist white women who struggled with self-esteem... Given my struggles with assimilation since high school, particularly so since starting medical school, adopting [healthy] habits to any extent over the long haul meant selling out some essential aspect of both my manhood and my racial identity -- even if my rational mind knew such a belief was self-destructive. It was not so much the differences in the food or exercise themselves as what the lifestyle change represented.

[His patient] Henry's progress caused me to rethink my distorted logic. He was a middle-aged, working-class black man with significant mental illness who required long-term use of a fat-promoting antipsychotic medication. In short, he was not the sort of person I would expect to succeed in revamping his lifestyle. Yet he'd been able to do just that ...

Both Henry and Dr. Tweedy had both affirmed that their own Black Lives Matter. I've been awed by watching black friends who've identified with that affirmation become enabled to take care of themselves as part of the struggle to care for all Black lives. This very bourgeois story is Tweedy's contribution. If you have any interest in either the US health non-system and/or the struggles of black doctors within it, this is a good place to broaden your horizons.

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