A black psychiatrist reflects on race in medicine, and being mistaken for a fix-it man

Dr. Damon Tweedy was one of the first African-Americans to earn a scholarship to Duke Medical School, back in 1996, when the school was trying to encourage more diversity in its ranks.

The son of a grocery store worker, Tweedy grew up in an all-black neighborhood where his older brother was the only person he knew who went to college without a sports scholarship. Now a psychiatrist at Duke, Tweedy says he has been frustrated about the quality of medical care he can provide for patients who are uninsured, many of whom are African-American. He has also written, in a New York Times best-selling book, “Black Man in a White Coat,” about the racially charged experiences he had as a student and young doctor.

He spoke with STAT about his experiences and views on today’s medical climate at the Spotlight Health conference, part of the Aspen Ideas Festival. This conversation has been condensed and edited for clarity.

What do you think it has meant for your patients to have an African-American psychiatrist?

I’d see a white patient [in my practice], and the first thing they’d say is “My friend is black.” Sometimes people would be curious, almost like you’re some sort of oddity. How did this guy come to this place?

Unfortunately, it is a bit of an oddity to be an African-American doctor, isn’t it?

The numbers peaked in the mid-90s. It got to where maybe 6.5 to 7 percent of entering medical school students were African-American. The numbers have since gone down.

Among practicing doctors the number’s actually about 4 percent. This poses a real problem, because so many of the places where doctors train are places with very large African-American communities.

The clinic I was in during my training in psychiatry, about 50 percent of patients were African-American. I was the only African-American provider. It was sort of this weird dynamic that I [should] be the one to see all these patients. It created this unrealistic, untenable dynamic.

Is there an obvious or easy solution to this lack of black doctors?

Clearly there’s a pipeline issue — getting folks in the pipeline who are going to be prepared along the way. That’s a huge part. Some schools take a very passive approach to recruitment.

Has the medical school at Duke changed in the two decades since you were among a handful of African-American students there?

Duke has been one of the schools that has been among the best. It’s been a real leader nationally.

What did you see as a young doctor between the care you were able to offer at Duke and the care you provided rural blacks at a clinic where you volunteered?

One woman really stuck with me. African-American, early 40s. She had fibroids, which is a really treatable condition, much more common among African-American women. She also had really high blood pressure.

We had run out [of sample medications]. She was the last patient of the day. If you can’t control high blood pressure, how are you going to treat her fibroids? She was uninsured. I’d always equated this idea that a job and health insurance go together. And in many cases they do. She was married, she had kids, but still she was falling through the cracks. It was really an eye-opening experience to see how perverse the system was.

Did you always want to be a psychiatrist? 

I actually didn’t like psychiatry when I was in medical school. Cardiology was what I was most interested in. Eventually, I did research where I was working with cardiologists. They were studying how do behavioral factors — meditation, exercise, diet — impact the heart. I saw the impact of the mind and the body, and it really drew me to this field.

There was this racial layer to it, too. I have family members who had some issues with mental health that went unspoken. There was this idea in the community I grew up in that going to a psychiatrist was something only a white person would do. They would say people have “strange ways,” but really the person had a significant mental health problem. There was all this talking around it and not acknowledging what it was.

You wrote about the time early in your medical school career when your professor thought you were in the classroom to change a lightbulb, not to learn. How did that affect you?

I felt like I had to prove to this guy that I really did belong. I was studying around the clock, sleeping three hours a night, studying, studying, studying. You always hear this “You’re the affirmative action person, you’re not cut out [to be] here.” I really had to prove that narrative wrong.

On the final, I got the second-highest grade in the class. I showed him my exam and he was really surprised. He looked at my paper, he looked at my ID badge — not believing this is one and the same person. After that, everything did change.

At first, I was someone who didn’t belong, then I was something beyond great. You feel a whole mix of feelings. You feel happy that you succeeded, but it still shows that there’s this bigger problem. You just want to be a student like everyone else.

You talk about having one very positive encounter with Dr. Ben Carson, then a neurosurgeon at Johns Hopkins University and most recently a Republican presidential candidate. What was that like?

Ben Carson would invite all admitted or accepted African-American students to meet with Johns Hopkins medical students. He would bring you to his house and you would have this chance to meet with him, residents, faculty. It was this whole grand event he would do every year. He also brought kids from the inner city Baltimore — this whole idea of racial uplift, role modeling from different stages.

What kind of reactions have you gotten to your book?

Duke’s been really positive. I was worried about that at first.

Some people were really amazed that these issues even existed, these issues of racial differences in health. There were other folks who said the only issue that’s important to race is the criminal justice system. Most of the feedback’s been really positive.

I’ve had so many people say, “You really wrote my story. You put a light on this larger issue.” I’ve also had a really good response from people who are not African-American, but can take my story and apply it to their own experience — a lot of female doctors say they can relate. All these dynamics are happening whether we acknowledge them or not. My lens is race, through the African-American experience, but there are a lot of others.

What’s your next book going to be about?

This issue of stigma. Stigmas exist across society in mental health. In some ways it’s accentuated — disparities are even more dramatic in mental health. The kind of mental health care you can get or not get based on [whether you’re insured or not] is dramatic.