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 r