Black Man In A White Coat

[Everette Oxrider]

Tweedy’s book in conversation with our Wednesday lecture on, “Understanding How Racism & Political economy Affect Health, Illness, & Survival,” illuminates the ways in which vulnerability (including but not limited to socio-economic status, race, etc) impedes (if not exacerbates) health care outcomes of these communities. I really resonated with Jane’s comment on our too-often association (as a collective society) and understanding of “race as biology.” Echoing off her point that such, “erases the multi-dimensions of people,” I find that our confusion and conflation of “race” and “ethnicity” often leads us to naturalize race. This — argued by many social scientists— is highly problematic. In an article I read recently on the role of race in direct to consumer (DTC) genetic testing, the author takes a similar stance as Dr. Thrailkill, noting that operating under the assumption that race is biology, is a risk in that, “other ethnic characteristics that emerge from a more localized perspective of identity— diet, language, environment, cultural practices, political history, all of which may significantly impact relative risk for the onset of disease— are rendered invisible” (Lee, 556).
Tweedy makes it clear in his book that our assumptions about people — influenced by the structures of racism, sexism, classism, etc—sift patients into categories of deserving care and not deserving care. Tweedy remarks on this in his chapter “Baby Mamas” when he observes the treatment of a young black woman in the obstetrics ward of the hospital. Soon after the senior physician enters the room to care for this woman, she brutally asks, “When is the last time you smoked crack?” (Tweedy, 35) Tweedy—shocked by the doctor’s harsh tone towards this woman— started to run questions of, “What was it about Leslie that made Dr. Garner so certain she used drugs? Was it her appearance, her speech, her race? Some combination? Would Dr. Garner have done that to a Duke graduate student, even one whom she suspected might have snorted a few lines? Or to any patient who looked and acted middle class?” (Tweedy, 35). Tweedy’s reflection and rhetorical questions post-this event encourages the reader’s critical and active participation. Though I think this specific example — as Tweedy touches on in his many questions following the event— could produce an entire paper about the role of race in medicine, the one thing I want to point out (as someone who pays close attention to language, hence my slightly pedantic rant above on the importance of distinctifying “race” and “ethnicity,” but I digress) is Dr. Garner’s choice to use the word, “crack” instead of “cocaine.” I found her choice of language to reinforce divisions of race and socio-economic status. These drugs are nearly identical in composition, coming from the same plant and producing generally similar effects, yet, of course, crack is the much cheaper alternative of cocaine, making it widely available in low-income minority communities (communities that have been historically — and are continually— disenfranchised in this country). Not only this, but cocaine is white— prestiged to be more “pure” (of course this is reinforced by the amount for which it is sold and WHO it is sold to) — and crack can be found in a solid rock color that ranges from a cream color to a tan or light brown. Thinking about how even the color seems to reinforce, “for who” these drugs are tailored to, and urges us to reflect on the vulnerabilities of these communities and how they are related to health.

Lee, Sandra Soo-Jin. 2013. “Race, Risk, and Recreation in Personal Genomics: The Limits of Play.” Medical Anthropology Quarterly 27 (4): 550–69. doi:10.1111/maq.12059.

Tweedy, Damnon . 2015. Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine. New York : Picador.

[Anna Wakita]

I agree with your thoughts– there is certainly a danger in over-generalizations, especially when ideas are compounded with sensory information like visuals, language use, etc. This was the fault in cultural competency, in which medical providers often relied on cultural stereotypes instead of actually trying to understand individual circumstances. The medical system further exacerbates this, starting with medical school admissions and the lack of caregivers available to the population. With so many doctors and caregivers outnumbered by patients, it is difficult to take the time to listen to patients’ stories. The general idea of medicine, to generalize patients based on medical history alone, also pushes caregivers to categorize patients within a recurring, stereotypical framework in order to become more efficient and get through with more work. The problem with this thinking, however, is that more efficient doesn’t necessarily mean better outcome, especially within the realm of health within the context of deep social issues.

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