Examining Race and Medicine

As part of the Middlesex community’s efforts to investigate the pervasiveness of racism in everyday practices and policies, the School welcomed a virtual visit from Dr. Damon Tweedy, who spoke to students and faculty on an evening Zoom call on September 25. An associate professor of psychiatry at Duke Medical School, a staff physician at the Durham Veteran Affairs Health System, and the author of Black Man in a White Coat, a New York Times best-selling memoir, Dr. Tweedy discussed racial bias in health care, also sharing his own experiences as a Black student, patient, and doctor.

“When we think about COVID-19 and the national protests,” Dr. Tweedy began, “African Americans are front and center; but, with COVID-19, the rate of African American people affected is two to three times greater.” While the underlying disparities in health care that this statistic indicates are a revelation to some, such inequalities have a much longer history, he said.

When he started at Duke Medical School in 1996, he found, “Professors would say diseases were more common among Black people, or their outcomes were worse. Why? It was personal to me.” His grandmother’s untreated high blood pressure eventually led to a stroke and then heart failure; and, when a fellow student practiced checking his blood pressure, it was found to be very high. “I was only 23 and active. It seemed like being Black was bad for your health, which was a point where I began to reshape my focus.”

The medical profession, he observed, has done a poor job of researching race – neglecting or ignoring how ideas about a patient’s race can affect the quality of care given. If a doctor considers race a biological difference between people – or thinks that Blacks are just making bad life choices that cause poor health – such assumptions can lead to flawed decisions. “Some want to think doctors are immune to these ideas, but everyone comes from an environment,” Dr. Tweedy said.

He finds some hope in the young doctors he sees in medical school today. “They are coming to these schools understanding in a bigger context what these problems are about,” he noted. “There have also been some dramatic changes in curriculum in medical school in the last several years, which is most encouraging.”

Shifting to his personal experiences, he recalled many times when he was forced to realize that “you’re different, even if you want to fit in.” In medical school, a teacher asked if he had come to the classroom to fix the lights; and, when he was pulled over while driving home, a police officer first asked if he had a gun or drugs in his possession. “Clearly that person didn’t see a med student when he pulled me over. We want to flip the script on that.”

Dr. Tweedy would also periodically encounter patients who refused to be seen by a Black doctor. “I don’t think medicine should be segregated,” he stated. “I hope we’re not that damaged – but it speaks to where we are.” Currently, he added, Black people are underrepresented among practicing physicians and among students and faculty at medical schools.

The big picture, Dr. Tweedy stressed, is that “We are talking about life and death.” Advocating for universal health care, he asserted, “The political discussion should be ‘how do we do it,’ not ‘should we have it.’”

Reflecting on the words of Dr. Martin Luther King, Jr. (“If I cannot do great things, I can do small things in a great way”), Dr. Tweedy affirmed that one person’s actions can make a big difference. Because one teacher in eighth grade encouraged him take a STEM course, Dr. Tweedy began to envision himself as a doctor. To his Middlesex online audience, he advised, “You guys should never lose sight or think you can’t do something….Never lose sight of your individual power and capacity.”