Q&A: Damon Tweedy M.D. '00 on race and medicine

Damon Tweedy M.D. ’00, assistant professor of psychiatry, is the author of the widely (and favorably) reviewed Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine.

What were some of your early shaping experiences?

I grew up in a working-class area outside Washington, D.C., and went to a not-so-great middle school. It was about 95 percent black, and many of the kids there were not on track for success. A math teacher suggested I take a test that eventually got me into a science-and-technology magnet program. At the University of Maryland, Baltimore County, I was a Meyerhoff Scholar; the program encourages African-American students into science and medicine. The summer after freshman year, I did research with an African-American cardiologist at the National Institute on Aging. It was great to work under someone who looked like me.

And that led you into medicine?

I was interested in cardiology for a long time. Eventually I realized that I had a knack for getting people to open up to me, and that’s what got me thinking about psychiatry.

You write about one of your Duke Medicine professors who approached you during a class break and assumed you were a maintenance worker. You seemed to let him go unchallenged. Any second thoughts?

I was already on fragile ground about whether I was going to make it in medical school. And here was a professor who was going to control my next step in the process. So I wasn’t sure about confronting him, or if he’d even get it. For me, the only way to prove I belonged was to excel. Basically, for the next month, I stayed in my room and studied. I ended up getting the second-highest grade in a class of 100 students.

You mention that the percentage of African-American medical students is tiny compared to the representation of African Americans in the general population. What keeps those numbers so far apart?

That points to bigger issues in society, including economic disparities. Becoming a doctor is an expensive undertaking. You also need the right educational opportunities to put yourself on a strong academic path. And we have to acknowledge the cultural perception of what African- American success means. Historically it’s been a narrow conception, particularly for black men—sports and entertainment. If you don’t see a certain kind of success, it’s hard for you to envision that for yourself.

You also write that about 75 percent of white physicians say race doesn’t affect the treatment of patients; the perception among black physicians is almost the reverse. Who’s right?

It makes sense that well-educated doctors wouldn’t acknowledge bias in their work. Still, we’re all lured into “framing,” or generalized judgments of individualized cases: Here’s one black patient with a certain set of symptoms; he must fit the pattern of previous black patients. On the flip side, African Americans may see an issue embedded in race that’s really embedded in class. In any case, the doctor needs to be sensitive to patient perception. The doctor can have the perfect treatment regimen. But if the patient perceives a bias, that’s going to affect how the two of them connect, and how likely it is that the regimen will be followed.

One theme you address is that “Being black can be bad for your health,” in areas ranging from childhood obesity to heart disease and diabetes. How do we turn that around?

Education in areas like nutrition is a big need, and so is access to health care. African Americans are less likely to have a primary-care doctor; they may not have health insurance or the ability to pay for tests and medications. Economic disparities are a major factor behind all of this. And we’ve got to find ways to improve the doctor-patient relationship.

What have you learned from being on the book tour?

One thing is how much my experience has resonated with African-American doctors and medical students; people have told me, “You’ve basically written my own story.” But it’s also rewarding that so many people have been able to connect with this story—women and other racial and ethnic minorities, for example, who are not African Americans but who feel, in different ways in their own lives, like outsiders, too.

Click here to watch Damon Tweedy in conversation with President Richard H. Brodhead.