Build another one so that second one didnt split and produced more horsepower than they expected so it was a wonderful example of not only the innovative capacity of two small problems but also when something didnt work they didnt give up. They never gave up about anything and the perseverance of against the odds is a life lesson they can all benefit from. You can watch this and others online that booktv. Org. Duke University Medical center psychiatrist is the next on booktv. He talks about the challenges confronting black doctors and the disproportionate health burdens black patients face and remedies for better treatment and care. Welcome, everybody. My name is dana and tweedy. Thank you for cspan for recording this today. Its a great to be here. My book is called black man in a white coat and its about race and medicine and this is a great place to be to talk about these issues. So this is the place to have a conversation today. This is the book black man in a white coat for her. Why should i buy this book were read this book. So raises the topic on everybodys mind its all over the news of and everywhere we hear about criminal justice and Law Enforcement thats where we hear about it all the time. Its also an important issue in medicine and healthcare and thats what my book explores a. This is two years after the Civil Rights Act passed after the Voting Rights act and the statement was of all of the forms of inequality and injustice in health is the most shocking and most inhumane so that speaks to this idea of how it is vital to all of us but also how so many factors and society influence health and healthcare and so a lot of my book is about those issues. I want to preface all of that to say when you talk about race youre also talking about a political subject. That wasnt my goal as i set out to write it was a personal story and i want to put my experiences and those that i saw over the years front and center. When you talk about race it is a fair discussion often times by putting these stories front and center so thats where im coming from. This is part of what attracted me to medicine but reading the books and stories so few of them talk about race at all and when they do talk about race it is only mentioned in passing but for me it was an important issue all throughout my medical training in terms of the way people perceive me and also the lives of many of the patients that i saw. So this is a very personal story and i should tell you a little bit of my background as a way to understand my perspective. I grew up not far from here and its good to be back in the area. My family is over here and i grew up just a few minutes east of here and i was in a very working Class Community that i grew up in the. Pretty sure they have a reputation now a very wealthy community but that wasnt the experience i had at all and that wasnt a reality where i grew up and actually there were very few moral models for success in academics and the communities i grew up in and i had a Great Fortune of the Great Fortune of having my older brother who was ten years older than me and he was one of the few people that did succeed and was a great inspiration for me but that would have seemed alien to me at that time in my life but in eighth grade, i was in a sort of traditional Battle School 90 black and one day a math teacher asked me to take an Entrance Exam to a program and i was thinking it wasnt on my radar kind of funny when i did well and i got into this program and that helped transform the end of my opportunities that initially what got me on the track and then as i started to study the track i realized i was attracted to this idea of science be interesting if objectivity. So thats what i was thinking and thats what appealed to me of going into medicine and a large extent. When i go to medical school you may even say i had a post racial mind setting and that is a term that is used now and when i got to school i saw a very different picture and i wanted to read you the introduction in the first few pages of the book to set the stage of what it was like so giving you a sense of my background and where i was coming from and now here i am in medical school so i went in at went to middle medical school at Duke University soil and to read the introduction of what happened in the first couple of months and set the framework and then well talk a little bit about what all that meant. On a spring morning in 1997, jim harper a young man from durham North Carolina lockup in his twobedroom apartment with no clue that he would soon become gravely ill. The first sign of trouble seemed innocent enough. He figured he was tired from the previous days of work. His fiancee asked if he needed to see a doctor and he smiled and said she worried too much. Her anxiety went as she went to her job at kmart only to return when he didnt answer the call during her lunch break. When she rushed home a few hours later at the end of her shift she found jims boat across the bathroom of his eyes wide open and he recognized her and that his words were garbled. He couldnt say what was long or how what was wrong or how long hed been that way. She dialed 911 and within a half hour after an exam and cat scan of his brain it was clear what had happened. Just a few weeks shy of 40 he suffered a massive stroke. Doctors learned he had high Blood Pressure that had been fully treated but found nothing else to account for this. He had no heart problems, no aneurysm, no high cholesterol. He didnt smoke, rarely drank integrated street drugs. He wished basically had a lot of bad luck. About two weeks later i sat at the foot of his bed duke hospital along with another firstyear medical student i was shepherding doctor wilson eight bbravo just as privy weekly class to introduce us to clinical medicine. The class was the highlight of the week as they gave a break from the laboratory and provided the peak in our future lives on the hospital boards. We were crisp white coats for the occasion to look like the doctors we would one day become. His future seemed less promising than ours. A big man he had once been a Football Player and now he couldnt move the right side of his body. His face droop as saliva dribbled out of the corner of his mouth and given the lack of improvement doctors began to doubt he could make any recovery. They were preparing to send him to a rehabilitation facility. His face also as please have a longterm care unit where he might spend the rest of his life. Its a case is sad that is sad and he said as we walked to the conference area to discuss his illness. He started by telling us a stroke was consistently one of the top causes of death and disability in america than he told us about the risk factors going back and forth between us in a competition of sorts. An eager medical student fashion we rattled off the usual suspects, diabetes and high Blood Pressure, heart disease, with age, smoking and high cholesterol. When it was my turn again, doctor wilson indicated there was one important risk we would get a mention. He looked at me with a worried frown. This should be easy. I hoped it wouldnt come to this but as i was learning it always did. Race i sat looking back against my coat and our patient is black. Exactly he said as if i had narrowed the top score of my exam had some say this is the most important risk of all. The risk is high and in the younger groups such as the patient here its more like three to one or even four to one. When i was 14 my dads brother to withdraw it several hours just to see us for a few minutes died within days of collapsing at his home putting an end. A few years later my maternal grandmother developed dementia stole her mind and her body. They have high Blood Pressure. Our patients other risk factors hypertension. This is also much more prevalent and nearly twice as coming to matter how you slice it it is a big deal when it comes to stroke. Doctor wilson hammered home something i would learn thai and again at duke and beyond. Being black can be bad for your health so thats the opening of my book and that sets the stage so im coming from a background and it was the large prominently white background and seeing a patient it reminds me of my past wasnt only an academic connection to a personal connection to it and so every time you learn about diseases its more common for me the followup questions were why isnt the case and what can we do about it. It seemed like i couldnt get answers to those questions. It wasnt something they could offer an explanation for. So thats one big part. Theres this whole issue of the poor health in the community and what thats all about and so in the book i laid out in three different layers so there is a layer of the system or the society and how that impacts the health of black people so theyre more likely to live in communities that are segregated. They have examples in the experiences to illustrate that. This is in North Carolina so we went to a cherry clinic about 90 minutes away from the campus. So you would go out once a month and look at people in the Charity Clinic so it was about 50 50 but the patients but you saw were all black and they didnt have Health Insurance and it was clear as you got out there that kind of care you wanted to provide you couldnt, despite your best intentions they didnt have Health Insurance and so the medications you wanted to prescribe all these things you couldnt do for the sort of substandard ways of it was obvious the experience that i saw so that was in the world setting so that was one of the communities i talk about and i really sort of talk about the couple of patients that i highlight there is one woman in particular i called her in the tina a 40yearold woman with high Blood Pressure who was having bleeding. Excess bleeding after her menstrual. And so the cause was called fibroids that is common in African American women and soap but she needed was medication to treat death but also some sort of medical attention to address the problem it can be a serious problem and so here we are in the clinic with a woman that has no Health Insurance and we came to the clinic with samples that they so we were not able to give her any medication and her Blood Pressure was very high and she was unaware of it so here we are with this woman. Later i saw the same problem they were all treatable and preventable and it came to me to me one day we rode out to the ambulance in a Housing Project in atlanta. We were struck by it and there is a scene in the book i describe where theres these two boys playing back and forth and it reminded me of myself in a way that they are out there and theres trash and broken glass and rodents and playing in the midst of this i was struck by how those factors play into health and it struck me to see that. Were talking about things like poverty that has a role to have a role to play in the outcomes. What can what kind of trust what kind of trust do we have an army on the same page, does the patient feel that the doctor has his or her best interest at heart so the book explores all of the angles of this. Theres so many other examples as well. Its what they expect and getting the right treatment and so it was a huge issue. Theres this whole other side. When doctors discriminate between two the best they can. In the book i describe two examples. One of the patients is a 50yearold africanamerican man that comes to the hospital with chest pain at first you want to make sure they dont have a heart attack of course and make sure that wasnt the case we ran other tests to come up with a plan for him and this was a Public Hospital setting at the doctors were surprised at how much he knew about his health and i think it caught them by surprise so much that they began to lose sight of the issues and wondered if this gentleman had some kind of band anxiety that was a weird interaction and for me they talked about it in such a way that i was blown away by the experience but it was one of these kind of examples and i talk about that a good deal in the buck. This is the case where im in my early 30s at this point so about ten years or so my knee was injured and i have been playing sports and i went to the clinic to get it checked out, have on sweatpants, tshirts, not dressed like this and the doctor didnt the doctor didnt look at me or give me any kind of eye contact and he had me stand up and down but it didnt engage with me and told me everything was going to be okay without knowing the problem in a way so as a doctor and that was more than needed to be done so i needed to know what i thought like i had to do in that situation and everything changed. I was a person you wanted to get to know and examine and everything was completely different it was an example of being two different people and one person is off the street and another person it was just different how people could be treated so thats another example i talk about in the book as well so we have the doctor and the patient and then the individual level how people are taking care of their own health and to talk about that in the book. There were two gentlemen that i saw one was able to make the right decisions in health and he was able to lose weight and take care of problems and the other one didnt and he ended up having a consequence as the result. What was the reason so i put myself in the middle of that and hoped one and not the other so thats an important piece to talk about as well. Those are the leaders that we have these problems and so thats what i outlined in terms of why do we have this to think about in all three ways so thats one part of the book. The other part of the book is what is it like being a black doctor in terms of how people perceive me so that is another huge piece of the book. When you think about the numbers in society talking about pretty stark differences and theres implications for that but i explore in the buck when is this idea that if you are the only black doctor many medical centers and hospitals are in the communities with very Large Populations at North Carolina is the definition of a 40 . Thats another leave medical school and baltimore is 60 of blacks that there is this thing that has replicated all throughout the country where doctors are being trained but they are in these here in these communities that have these Large Populations. What also happened for me in the community where a community where theres this Large Population they often want to see the position not always but often so there was a struggle to provide care about was one issue also i talk about that in the book as well and i get a couple examples, so i am in psychology and thats one of those fields where a doctor and patient relationship is important and primary care is imported. Spinning she had come to the clinic with depression and anxiety that that was but that was the heart of what it was about. For reasons im not sure that we end up getting paired together so im not sure if that was done by someone pulling the strings or if it happened naturally. But at first she had reservations. But we were able to play buy everything out and get at the heart of things. She had been seen before in her treatment was primarily education and focusing on symptoms and we were able to talk about what was going on with her. There were always concerned i was able to relate to and i think that i was able to connect with her and help her and she made tremendous progress so thats one of these examples of how things could work in these settings. So those are some of the layers of being africanamerican doctors. There is also this idea how people perceive you. Then also been healthcare and medical system how do you navigate the two things . People have certainly perceived me in a very unfavorable way so in the book i will talk about a couple examples and there was one incident in medical school in the book opens with that where i met firstyear student and i walk into a classroom and the professor comes up to me and he asks me to fix the lights in the classroom and then he says i called about this the week before. Why havent you done your job and it was a case of mistaken identity. But first why was he thinking about me, was there something i did wrong, did i not dress the right way, but then i realized the reason i looked different in other people in the class was the issue at hearts of the book talked about that episode and how i dealt with it. I dont want to give it all away but that was a similar moment in my early medical school experience. Then there was another time when i was a young doctor this time im a brandnew doctor. There was this whole layer that i faced. His first words in the hospital want to say can you treat my pain. I was the only black doctor there in the hospital so i guess that its karma. Theres a surprise ending in the story but in this particular case his family was, too and it was so that was another example of what it was like to be a young black doctor in the environment. But then im coming apart in this other system in this other world and im trying to navigate the two that you try to find out where you belong. They argue on this side or that side are you in the middle so that was a struggle that i dealt with so as i see patients in the training and go through the process with the layer of the public is about i want to have that feel for things. That is another question that wasnt answered in the first year. So in the book i talk about that so i talk about the Affordable Care act and its been to help access to care that is a huge issue in the communities of that was one of the goals. I think its helped in some ways but its been so partisan and so politicized and its undercut in many ways its effectiveness for instance, i am in North Carolina and that is one of the states where there was a medicaid provision to expand the Affordable Care act and that didnt happen and thats one of those states theyve declined so i went back to the clinic about a year ago that ruled that the Charity Clinic and saw some of the same patience and i tried to take stock of where things have come from now. They have a regular doctor that sort of always there to see patients that many of these folks fall through the cracks not having Health Insurance but the needs of it is a significant problem that we are dealing with and i take stock of that in the book. There is also this whole bit about doctors and patients and where we are with that with issues that trust and communication and explores that where we were when i started and where we are today and to really make a point of teaching them how important his issues are not only to understand history and race and to be able to treat people as individuals and to understand them as individuals. So im black and they are white and there right and there is a superficial difference in so what i talk about is how i was able to have several patients that first we have nothing in common but how i was able to help make connections and how the two of us from different worlds were able to connect and that could be used as a model for other doctors so i went out to be a big part of what the book is about as well. The third piece is about the individual part, what can we do so again i use myself as an example. In medical school i was diagnosed with high Blood Pressure. So im 23, 24yearsold thinking im on top of the world, former athlete and i get struck with this diagnosis. The doctors were concerned that i get early signs of kidney problems. Was pretty significant. The book throughout the story to tell you how i progress through that and to challenge that and changing my diet and the way that i lived and how hard that was and how there was a huge cultural peace to that from the background i came from and the struggle i dealt with in assimilating this other world so i think that is an important issue that i talk about but that is a big piece of help that we can do as individuals as well. So the goal is to educate people because they dont know about the problems. One of the things that we have seen in the early interactions with people that the press they are never aware there was this issue of problems in the community so it surprises me that i see it over and over again. So it is really educating people and so the other piece is to inspire able to do better. But the system, with doctors and us as patients these are my goals in writing the book so thats where im coming from and thats where i mac so i can take the questions at this point in our. Im looking forward to reading your book. I know this is a personal story but i think a lot of people will learn from your experience. You talk about the difficulty navigating coming from the perceptions. What tips would you give to others that are in college now to better help them navigate and maybe avoid or deal appropriately with the situations that are bound to come out and medical school, corporate, what have you learned that you can share with others . It could be any other business absolutely. The feedback ive gotten from people in other fields they say i can relate to what youve experienced and they use that as a weight and thats very true. As far as what we can do there will be times that you see people coming up against those that think less of you or think that you are less than capable sometimes you have to pick your battles and not lose sight of the goal and become consumed by those things and that could lose focus on what youre trying to accomplish but sometimes you have to let people know that they are wrong and you have to you have some cajoling that you have to do. But not losing sight of that and having the support system is important as well so those are the things that you need to see at this point. You said that you were part of the program in Prince George county. I was wondering what high school you graduated from. To prepare you from Duke University and medical school after words. It was a really good program. After that i went to college in Baltimore County and that was also a Science Technology program and i was well prepared. It was this whole other piece that i struggled with. I was very wellprepared academically, absolutely. Now you are teaching students that i think through your discussions youve obviously highlighted the need for physicians to be educated. How do you use your experience to help educate and how they interact with patients of color. As far as i know actually a lot of physicians have talked to me after ive written this book theyve read it or heard me on the radio and said thank you for bringing up these positions so one element of that is in the book that can hopefully achieve in the book and as far as what i do with the doctors i work with as far as my colleagues, yes. [inaudible] you need to be trained just like a police officer. You need training on how to deal with people of color who looked differently. And because i come from the pharmaceutical biotech industry and they interact with many doctors and hope that my grandmother wouldnt be treated by this doctor that automatically they dont want to pay for this medication you dont know anything about the family but they make these judgments and assumptions, so it should be more. There needs to be an initiative to say we have to train all doctors and hold them accountable. A lot of places are trying to do that. Its not happening everywhere but there are many hospitals they are building that into their building it into that. Theres a Concerted Movement and many hospitals and state medical societies. Im wondering in the audience is this for academics and Health Care Professionals . I find that a lot of people could really use your knowledge. From the interviews im gathering that your book is full of academics and Health Care Professionals is that true . Its much more for the general audience. Thereve been books written about the statistics and the kind of dry presentation. Its really a very personal story and so putting peoples stories together. At predominately gets the cases as well and people are scared to death of Mental Health care they absolutely are they dont talk about it out loud so they need something with more teeth. Thats why it was wondering if your book was more geared towards people other than just academics. She raised a good point she talked about Mental Health in the community and that is something that we see quite a bit. We see africanamerican folks really i need is for the other part of the society. We can have it in the huge stigma so i see that a lot and that is a good point that i encountered quite a bit and i think that its one of my missions in the words but i do to be stigmatized Mental Health care and the need for it. What do you see as a doctor with the free healthcare act . The free healthcare act . Obamacare. Like in canada you mean what are my views on medicine or is that what you mean . Thats a good question. I think that there should also be a basic level of healthcare for everyone in some way so im not sure if i know the answer to the system. Every system is going to have problems but to take a step back you can see how im not not having Health Insurance affects them to not get treatment and delay treatment, awful things happen because they dont have Health Insurance. Thats happened so much and they would get sick because they delay treatment in Emergency Care and then the next thing you know they are in financial ruin because they had to get care and they didnt afford it so they lose their housing house and you see all these bad outcomes. Theres no doubt that we need a system that can ensure people so yes i would agree with it. Questioned. Do you still see some improvements . Have i seen any decline in North Carolina backs. The jury is still out because the Affordable Care act is still new and we are dealing with the purpose and railings that there is no doubt there has been some progress since the time i was a medical student at the progress has been slow and its not just even processes you take a step forward and back but there is some progress but not as much as we would like to thats what i would say about that. In this discussion they dont think that it really prepares them for the corporate world or the medical world. Do you think that it could make the transition a little bit harder . She asked about the perception by some that it may not be the best place to be educated by the corporate world. If you look at the track record of so many successful people with his tremendous not only in healthcare but in the law so i would definitely not say that. It could be helpful in terms of their selfesteem and things like that so i definitely wouldnt discourage people from that route. Question back here. Can you talk about why you chose psychiatry . The question is why did i choose the psychiatry. I thought that i was good to be a cardiologist and i was interested in a the sort of procedures and being objective. I took a rotation but i did my last few months of medical school and took this course that was available and it was great. I was in the hospital and i got to work with patients that were sick from a psychiatric standpoint that have medical problems and it just opened my eyes to psychiatry and i got great feedback. They would tell my supervisor i was good at coping people in so that worked out well and as i got into psychiatry there were other pieces about africanamericans and the whole idea of it not being an issue or one that was acknowledged, so i found my place in psychiatry so thats where it all came about. I want to do a followup on that you are in North Carolina so how did that route given the fact that they are different with mind, body and spirit and would need different treatment than the average americans. This issue of eugenics there is a bad issue with that. It was one of them that was most aggressive in the program that was from the 1930s to the 1974 the year i was born as when is when it stopped so there has been a big issue about compensating the victims and theres been a lot of issues around that but the one thing that i would say one thing they learned in writing the book is that these are happening everywhere so its not just the doctors in the north and the west they are being replicated everywhere so there is an aspect even though the south has its own history for sure even california was a state that was big into eugenics so it is a nationwide problem and not a regional problem. Another questions are. Im sorry isaac payback in that case im a doctor. Im a biology major. I just want to know [inaudible] one of them when i was in the science and Technology Program a lot of it is about seeing people who you can relate to doing what you want to do so when i got to college i was able to work in the lab and he played a big role. This was a guy that looked like me and thought maybe theres something i can do so thats the point i decided i wanted to take that leap so a lot of it is about the opportunity and its a big issue. Are there any situations where you reconsidered if that was the right field and what kind of kept you going. Theres no doubt about it it doesnt matter who you are it can be a tough road and there were times i wonder if i made the right decision and maybe i wanted to not we didnt talk about this today that i went to law school and i got a degree in case i didnt want to do medicine i want to do Government Entity in the middle of things but then i took a step back because i realized i really liked seeing patients and their was something about being able to connect with people and make a difference in their lives you cant replicate in so many other areas so thats what brought me back to it. It sounds like something you might read on a Hallmark Card or something but there was something valuable that brought me back into medicine. Any other questions . What are some of the things that stand out to you . [inaudible] actually i do ive been part of the Mission Community for years now and its coming full circle. Theres been as concerned about the focus on numbers. Theres been a concerted effort more so. Its a work in progress to get to know people rating the application understanding where they are coming from so there is a lot more happening in the applications more so than was happening in the years past so we are going towards the process. One of the things a lot of People Struggle with how africanamerican men in particular the numbers are going down in terms of the application so that speaks to a lot of different issues and a lot of it is having role models and about people knowing the process and the path, so thats an important piece as well. Part of what we do is outreach to schools. Theres a lot for instance in North Carolina and we try to reach out to the students there and help them know what they need to do to get where they need to go. That is a big piece of what i do. Great. Final questions . Thank you, everyone for coming up to date. I appreciate it everyone. [appla