Black Man in a White Coat, 54-102, 105-152

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  • #870
    Grant Glass
    Keymaster

    Black Man in a White Coat, 54-102, 105-152

    #960
    cestelle
    Participant

    In Black Man in a White Coat, race is recurring theme. Race has affected how Damon Tweedy M.D. sees himself compared to his peers as well as how his peers and patients see him. One good example of this is on page 92. Tweedy brought up a good point about how being black affects the way he thinks about his race and its relation to his work, but also how he perceives people think about his race and its relation to his work. Tweedy asks if when looking at injured black patients, white doctors would ask “’What’s wrong with these people?’ Or were we projecting our own insecurities onto them?” At first, I thought it might be silly to think that other doctors and peers might judge him by race but I am ignorant to this as a middle class white woman who has not been in his experience. I think it is a tricky topic because although there are many people who do not believe race matters in a person’s ability (such as myself) there are still people out there who think there is a difference. One example that really stuck out to me was the passage about the patient who did not want to be seen by a black doctor (page 108). It honestly blows my mind that there are still people out there who have such negative opinions regarding people of a different race – especially when they have gone through school, training, are obviously qualified to do any of the work expected of them. This passage really opened my eyes that there is still so much discrimination, both obvious, like the example above, and subtle such as how the doctor viewed the black women who was on crack and had a miscarriage earlier in the book.

    #965
    amacha
    Participant

    Dr. Tweedy grew up with relatively poor dietary habits that continued into his young adult life. He was able to change his behavior, habits, and attitudes towards exercising and eating right that ultimately led to his healthier lifestyle that reduced his potential of getting high blood pressure related issues. He was very privileged that he was able to control his health in such a way because for many Americans this is a challenge that they may not overcome. The odds are stacked against them even more so if they are uninsured and poor.
    “I stood before them face-to-face with my family’s past and perhaps my own future”
    This quote from page 73, really highlighted how much of people’s health outcomes are not completely determined by individual choices but are very influenced by income, occupation (and whether it offered health care), race, and gender. Everyone is a product of their choices, but we do not determine the choices that are given to us. How is he able to trace a history of high blood pressure and hypertension? There are structural inequities in place that allow and permit systematic oppression that leads to effects that last generations and will continue to do so unless something changes.
    Reading about how a doctor can be just as unhealthy as a non-medical professional is really humbling. Often I think of people with medical degrees would be at peak health but it also sounds like they have no time to obtain health themselves in terms of their diet, sleep, and mental health as they are in medical school and training. There is this irony that those who work to keep us healthy are often burnt out and spread thin according to Dr. Tweedy’s book.

    #968
    kmwelsh
    Participant

    Black Man in a While Coat is a novel written by Damon Tweedy about his experience through medical school and becoming a physician. He explains the hardships of being a physician and the extra pressure of dealing with racism in the medical world. Tweedy has to second guess himself many times throughout the novel. He is not second guessing himself because he thinks what he has to say is wrong, but rather, refraining from speak up to racism out of fear of jeopardizing his career. An example of this is in chapter six. Tweedy and some of his supervisors were treating an African American male named Gary. Gary was seeking treatment for high blood pressure and other health conditions. Tweedy’s supervisors suggest that Gary start a new medication to lower blood pressure. Gray (whom Tweedy describes as insightful and level headed) tells his doctors that we would like to try making life style changes before switching to medication. This resulted in Tweedy’s white supervisors clinically diagnosed Gary as OCD, simply because he did not follow their orders. Tweedy wanted to stand up for Gary, but he realized that his supervisors would not listen to what Tweedy said and perhaps suggest he needs to talk to someone about the pressures of his medical training. This situation is an example of how Tweedy had to second guess himself and stop himself from doing what he thought was just for the patient, because it could have risked his reputation, and in medical training, one’s reputation can have a serious impact on their career.

    #970
    courtab
    Participant

    I thought that our lecture on understanding racism and the political economy’s effects on health, illness, and survival this past Wednesday was really relevant to this section of the Tweedy reading. Demographic and class factors play a huge part in who is at risk, who receives care, and what quality of care they actually experience. In Black Man in a White Coat, Tweedy mentions a story about three New Yorkers (of varying social classes) that each have a heart attack at the same time and the different journeys they experienced. The New York Times found that the wealthy heart attack patient recovered quickly with little to no complications, the middle-class man had a minor complication, and the working-class woman suffered many complications that made her recovery slower and more difficult. Clearly, the amount of money that one has available greatly changes their level of access to high quality medical care. Statistics and stories come into play here; we need both in order to understand trends like these, and how class factors are intersectional with those of race. Both stories and statistics are necessary to track the quantifiable information in order to structurally adjust social programs and institutions, while stories are very important to showing the more personal effects that illness, race, and class-factors can have on people.

    #971
    courtab
    Participant

    Hey, I really liked this post!
    I absolutely agree with you that it is humbling to hear of a medical doctor’s own struggles with health despite his extensive training surrounding the subject. It’s something that nobody would really expect, since we all want our doctors to somehow be super-humans with super-bodies and super-brains too.

    / I mean c’mon, is that too much to ask? /

    Of course! The burnout experienced in the medical profession is insane, and this is partly due to the crazy expectations placed on them in a system that doesn’t allow them to care for everyone that walks into their clinics. Like Tweedy mentioned on his rural rotation, there are people who can only visit the doctor once a month with chronic illnesses and the doctors they see aren’t always able to prescribe them what they need due to insurance issues. Structural issues like these seem to be everywhere, and I loved how you related it to his quote about facing his family’s past. Truly, chronic health problems like hypertension of mental health issues can be intergenerational because they are comprised of an extra-biological social component in addition to just genes being passed down from parent to child. Factors like income are determinative when it comes to health, and class mobility in America is extremely difficult when those living in poverty are often denied the resources to lift themselves out of it. Often times they’re disadvantaged even further by poorer education, welfare services with myopic criteria, and a lack of access to affordable healthcare. I guess your post just really made me think about how great it is that Tweedy’s education allowed him to reconcile his family’s past health issues, but how many people sadly don’t share this same experience.

    #972
    Lauren Smith
    Participant

    Tweedy’s encounters with Pearl and Tina at the clinic in chapter 3 were particularly rich parts of the book. Working at the clinic was a transformative experience for Tweedy because it made him reflect on his own health struggles and the contrast between him and Pearl and Tina. Like Pearl and Tina, he has high blood pressure and had had contact with the culture from where they were coming; he was familiar with the colloquial terms of “sugar” and high-blood” because of his grandmother. Unlike Pearl and Tina, Tweedy understands “the language of medicine”, has access to university gyms and sources of healthy food, has health insurance, and has a stable doctor-patient relationship (73-74).
    Here, as he does throughout the book, Tweedy weaves in historical and socioeconomic contexts to supplement his personal anecdotes. He writes “Given these glaring differences, it should come as no surprise that the poor and uninsured as a group have worse health outcomes and higher death rates than people with health insurance” (74) and goes on to cite various studies. Prior to the clinic, Tweedy had no awareness about the uninsured, but afterwards posed questions about the healthcare industry and its responsibility to people. This anecdote and statistical knowledge reveals something that’s hard to believe, that one’s chances of living or dying is heavily impacted by one’s circumstances in life.

    #973
    Lauren Smith
    Participant

    courtab, I thought that New York Times article about the three patients was unbelievable, but it did a really good job highlighting how significant structural circumstances are to patient outcomes. I also liked your point about how statistics and stories need to come together. That’s one of the things that makes this book effective, Tweedy combines his anecdotes with other studies/research and anecdotes from books written by other people who have had similar experiences

    #975
    milansak
    Participant

    One story that I really found moving was Dr. Tweedy’s encounter with his patient named Chester. Although the situation was rocky in the beginning, both Dr. Tweedy and Chester’s family came out of it a lot different in the end. But what particularly amazed me was how honest Dr. Tweedy was with himself. He willingly admitted to what he could have done differently in that situation. For example (p. 128) he mentions how he “countered prejudice with prejudice” and his clinical diligence ultimately was shown to impress his colleagues while viewing Chester’s family beneath him. I think that this level of honesty is what makes this such a good book. It’s moments like these when I realize that okay, Dr. Tweedy is human. He has his up and down moments, he achieves in some areas while failing in others. He’s not all about making himself look good as a doctor.
    I couldn’t imagine some of the emotions that cut deep for him in the face of discrimination–having to go through those awkward patient encounters he described, being asked if he was in class to fix the light and more, all while working these long and dedicated hours as a doctor, yet it’s seen as “not good enough” cause he’s a black man.
    But I respected how much his experience seems to humble him. He recognizes what’s happening around him and uses it to better himself–a realist’s perspective. Referring back to the Chester experience, it shows how much adversity really does build your true character. This was the reason why I could not put this book down.

    #980
    Iris Kang
    Participant

    Dr. Tweedy highlights a very eye-opening comparison between two patients who were uninsured for healthcare: Francine (who was diagnosed with uterine cancer) and Stephanie (a patient who had suffered a stroke due to her hypertension). While both were uninsured, because of Stephanie’s drastic health decline, she was put on Medicaid which ultimately allowed her to recover fully. However, on the other side of the spectrum, Francine remained uninsured. Tweedy discusses how appalling the circumstances for obtaining Medicare are–essentially, being in what he calls “doomsday scenarios” are the qualifying criteria for uninsured working people who are making only a small margin above the poverty line. This points to the inadequate social welfare system in the U.S. and we are still operating on a largely “treatment-based” system instead of a “preventative care” approach. A preventative care approach will allow more focus on disease prevention and be more specific to individual communities that have varying levels of resources and accessibility to care. A starting point to operating on a preventative care system can be implementing initiatives to make healthy food options and resources for low-income communities more accessible as well as investing in university-led and charity-based medical care facilities.
    I appreciate Dr. Tweedy’s efforts in bringing cases like Stephanie and Francie’s struggles with healthcare and insurance to light. I feel like these kinds of individual stories that capture what many Americans are experiencing on a personal and eye-opening level are not discussed as openly or often as they should in public.

    #993
    amacha
    Participant

    In response to Iris’s comment: “we are still operating on a largely “treatment-based” system instead of a “preventative care” approach”
    I definitely agree that there needs to be a transition to preventative care nationwide. I feel like there is almost an ethical duty of public health to do so because knowing that there are factors that contributes/ results in adverse health conditions and not doing something to help prevent it before it starts sounds cruel. It shows the unwillingness to change our ways. A preventative strategy would also effect the business oriented mindset of the health care industry. You make money by having patients who are sick, need medication, or going for check ups.

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