Dr. Damon Tweedy’s Grand Rounds: “Reflections on Race and Medicine in the Year of COVID-19 and National Protests”
“#BlackLivesMatter.” It is Instagrammed and retweeted, inscribed onto signs and roared at protests rippling across the nation. It is echoed everywhere yet seemingly not enough. As America renews and reexamines the tumultuous racial history that underwrites its present reality, it seems to many that the realm of medicine remains the only colorblind institution standing. We believe medicine is upheld by science, its practitioners trained to assume an objective lens when viewing patients and their illnesses. For clinical medicine in America to effectively care for the vast diversity of patients in the healthcare sphere today, this is a reality that must be recognized and addressed through targeted change.
Dr. Damon Tweedy, acclaimed author of Black Man in a White Coat and Associate Professor of Psychiatry at Duke University School of Medicine, presented this claim at this month’s Health Humanities Grand Rounds hosted by UNC Chapel Hill. Bringing forward a poignant and captivating narrative, Dr. Tweedy used his experiences to reflect on the clinical encounter, the social determinants of health, and medical education in the context of a nation combating crippling racial bias.
Dr. Tweedy deconstructed the medical system and its foundation, analyzing it through the perspective of racial bias and disparities in the clinical context. One of the issues at the core of medical education is that it frames race without an appropriate background, simply as a fundamental biological difference. Reflecting on his medical training, Dr. Tweedy recounted how patients are often racialized as black or white and prescribed treatment regimens based on disease demographics divided by black and white outcomes. Without considering the fluid racial gradients underlying patients’ identities and ancestries, a binary racialism is embedded in medical science—the scientific basis, Dr. Tweedy argued, for disparities in treatments and health outcomes. Underpinning conventional clinical thought is the flawed view of race as a major contributor to pathology, one that is often openly expressed by practitioners as a medical fact. While healthcare is striving to uproot this belief through mandatory cultural/racial competency trainings, like the remainder of our society, much remains to be changed in medicine.
It is not all too surprising that this clinical thought is embedded and transmitted through the medical chart, where it becomes difficult to extract. Dr. Tweedy described how physicians become storytellers as they translate patients’ narratives into charts that record and communicate patient care. The power of the medical record lies not only in its ability to document regimens of care, but also in its ability to characterize individuals differently. Practitioners often inadvertently depict patients of color as resistant to care, shifty, and even less in need of painkillers which greatly influences the perceptions of the healthcare team tasked with delivering quality care to patients.
Although tacit, the assumptions and perspectives of healthcare organizations are sensed by minority patients, contributing to a lasting mistrust of American medicine that only worsens health outcomes. Dr. Tweedy illustrates this through the contrasting experiences of a white and black lady who both present to the ED with a drug overdose. While the white woman who has health insurance is provided individualized care, the black woman does not and must be transported to the state psychiatric hospital akin to a prisoner in her very first encounter with psychiatric health services. It is important for healthcare systems to recognize, Dr. Tweedy highlighted, that such outcomes do not occur in isolation. The trauma patient’s experience penetrates to her family and communities, whose mistrust of healthcare institutions further deepens. The healthcare system must reform its reception of minority patients, many of whom have intersecting identities with unique value systems and worldviews. If they hope to understand the unique roots of patients, practitioners must strive to be sensitive to patient backgrounds beyond appearances and respectfully acknowledge their vital role in the healing process.
In this vein, the physician is not only a caregiver but also an advocate for patients, uniquely suited to bring change in a system that structurally perpetuates racial bias. As he retold his experiences as a black physician, Dr. Tweedy conveyed efforts to educate students and other providers about their own implicit prejudices as they seek to deliver care. Minority physicians, who are often entangled in a dual consciousness of conflicting racial and professional identities, must advocate for systematic change in the culture of medicine, which begins with diversifying providers to mirror racial population demographics. Some of the greatest barriers to this are the large time and financial commitment of medical training, the very structure of which was designed by a subset of individuals holding a particular set of values in mind.
While such large-scale structural change to the medical system may seem daunting, Dr. Tweedy emphasizes that it starts from the individual. Providers should ask themselves how they can contribute in small yet meaningful ways, such as making a greater effort to view their patients as part of a broader system of racial, socioeconomic, and political constraints, while examining their immediate assumptions in these contexts. As the United States grapples with racial unrest, medical practice mirrors our society, connected yet terribly fractured. Spurred by BLM protests, social media movements such as #ShareTheMicNowMed and #BlackinMedicine are digitally connecting minority practitioners to share their experiences with diverse audiences. Despite these connections, minority professionals continue to grapple with discrimination and bias in the clinic. I felt Dr. Tweedy’s quotation of James Baldwin most aptly summed his call for systematic reforms in medicine, “Not everything that is faced can be changed, but nothing can be changed until it is faced.” We must face the racial reality of medicine, starting at the individual level, to continue bettering the health and well-being of all.
Mili is a student with an interdisciplinary love for the hard sciences and humanities. She is particularly interested in pursuing trauma and critical care, and wants to deepen her understanding of individual patient experiences in the field of medicine.