Black Man in a White Coat Response

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    I have truly enjoyed reading Tweedy’s Black Man in a White Coat. It integrates cases that Tweedy himself has handled, while incorporating statistical evidence, ultimately creating a powerful framework of discussing health inequalities and racial divergencies in medicine. As such, I feel as though it would useful to analyze the final section of the novel, as Tweedy acknowledges that “a big part of the solution is discarding your assumption and connecting with each patient as a person…this approach is often called cultural competence, but after years of medical practice, it seems to me more like common sense” (Tweedy 245). The application of this ‘solution’, however, must integrate socioeconomic factors, and is better encapsulated by structural competency rather than its cultural counterpart. Tweedy himself describes socioeconomic barriers earlier in the text, as he showcases the limited nature of healthcare in rural areas, as well as in his analysis of personal behavior as it is informed by one’s means. Furthermore, Tweedy notes earlier in the book that he has “the knowledge and the economic resources to do better” (Tweedy 221), since he, as a doctor, is situated in circumstances that afford him the ability to take better preventative measures. While an individualized connection with patients is highly important, I feel that as though it fails to account for barriers beyond that of patient-doctor relationships, and does not account for his earlier discussion of economic barriers in healthcare, addressing educational limitations on behalf of minority doctors, and curtailing unhealthy practices in an effort to facilitate preventative care. Tweedy’s book was powerful, well written, and details factors in a system that needs change. Yet, rather than propose change himself in the final chapter, his approach is self-limiting in its unilateral appeal to doctor-patient relationships.


    I thoroughly enjoyed reading your forum post because I also loved the structure of Tweedy’s narrative. He describes personal anecdotes and then utilizes statistics to support his stories, while also leading the narrative into issues of racial disparities. I feel that doctors must care for each patient on an individual basis and disregard socioeconomic or racial identifications, as the most optimal care puts the patient’s health and comfort over everything else. However, this is a very hard thing to accomplish because social and economic factors do play a huge role in the process of receiving care. Keep up the great work!

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